Healthcare Provider Details

I. General information

NPI: 1912206970
Provider Name (Legal Business Name): LITTLE SMILES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1247 S CEDAR CREST BLVD SUITE 300
ALLENTOWN PA
18103-6298
US

IV. Provider business mailing address

401 COMMERCE DR SUITE 1087
FORT WASHINGTON PA
19034-2714
US

V. Phone/Fax

Practice location:
  • Phone: 610-628-1228
  • Fax:
Mailing address:
  • Phone: 215-550-7186
  • Fax: 215-646-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS-029417-L
License Number StatePA

VIII. Authorized Official

Name: PHI LE
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 215-550-7186