Healthcare Provider Details

I. General information

NPI: 1730550229
Provider Name (Legal Business Name): FRIENDLY SMILES ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 NEWPORT PIKE SUITE 304
GAP PA
17527
US

IV. Provider business mailing address

91 NEWPORT PIKE SUITE 304
GAP PA
17527
US

V. Phone/Fax

Practice location:
  • Phone: 717-442-3639
  • Fax: 717-442-4241
Mailing address:
  • Phone: 717-442-3639
  • Fax: 717-442-4241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS039407
License Number StatePA

VIII. Authorized Official

Name: DR. MAN YEE CHAN
Title or Position: SOLE MEMBER
Credential: D.M.D.
Phone: 717-442-3639