Healthcare Provider Details

I. General information

NPI: 1689033151
Provider Name (Legal Business Name): PERFECT SMILE DENTAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 ARDMORE BLVD STE 169
PITTSBURGH PA
15221
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: 412-824-0493
Mailing address:
  • Phone: 814-942-4699
  • Fax: 814-942-4587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS038278
License Number StatePA

VIII. Authorized Official

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