Healthcare Provider Details

I. General information

NPI: 1912238767
Provider Name (Legal Business Name): DENT-AL SMILES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 YOST BLVD SUITE 215
PITTSBURGH PA
15221-5225
US

IV. Provider business mailing address

125 EAST 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 Number
License Number StatePA

VIII. Authorized Official

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