Healthcare Provider Details

I. General information

NPI: 1497327258
Provider Name (Legal Business Name): PERFECT SMILE DENTAL OF BUTLER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 EVANS CITY RD
BUTLER PA
16001-2601
US

IV. Provider business mailing address

103 EVANS CITY RD
BUTLER PA
16001-2601
US

V. Phone/Fax

Practice location:
  • Phone: 724-285-6853
  • Fax:
Mailing address:
  • Phone: 724-285-6853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: BECKY ROMANO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 814-942-4699