Healthcare Provider Details

I. General information

NPI: 1992180103
Provider Name (Legal Business Name): A PERFECT SMILE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ROCKBOURNE RD
CLIFTON HEIGHTS PA
19018-1722
US

IV. Provider business mailing address

290 KING OF PRUSSIA RD BUILDING 1, SUITE 310
RADNOR PA
19087-5107
US

V. Phone/Fax

Practice location:
  • Phone: 610-254-5081
  • Fax:
Mailing address:
  • Phone: 610-780-5179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS036277
License Number StatePA

VIII. Authorized Official

Name: DR. ANTOINE PANOSSIAN
Title or Position: OWNER
Credential: D.M.D., M.D.
Phone: 610-254-5081