Healthcare Provider Details

I. General information

NPI: 1477143568
Provider Name (Legal Business Name): PERFECT SMILE DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 ARDMORE BLVD STE 169
PITTSBURGH PA
15221-4608
US

IV. Provider business mailing address

125 E PLEASANT VALLEY BLVD
ALTOONA PA
16602-5544
US

V. Phone/Fax

Practice location:
  • Phone: 412-824-8830
  • Fax: 412-824-8830
Mailing address:
  • Phone: 814-942-4699
  • Fax: 814-942-4587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. PENG CHENG
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 814-942-4699