Healthcare Provider Details

I. General information

NPI: 1922124767
Provider Name (Legal Business Name): SMILEBUILDERZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 CROWN AVE SUITE 200
LANCASTER PA
17601-6310
US

IV. Provider business mailing address

204 BUTLER AVE STE 102
LANCASTER PA
17601-6307
US

V. Phone/Fax

Practice location:
  • Phone: 717-481-7645
  • Fax: 717-481-7655
Mailing address:
  • Phone: 717-481-7645
  • Fax: 717-481-7655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS036610
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS036800
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS018166I
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS027910L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 10
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS029837L
License Number StatePA

VIII. Authorized Official

Name: DR. ANTHONY P SKIADAS
Title or Position: OWNER AND DENTIST
Credential: DMD
Phone: 717-481-7645