Healthcare Provider Details

I. General information

NPI: 1346214954
Provider Name (Legal Business Name): ABOUT YOUR SMILE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6776 MARKET ST
UPPER DARBY PA
19082-2432
US

IV. Provider business mailing address

6776 MARKET ST
UPPER DARBY PA
19082-2432
US

V. Phone/Fax

Practice location:
  • Phone: 610-734-0115
  • Fax:
Mailing address:
  • Phone: 610-734-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS 025089 L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS 023270 L
License Number StatePA

VIII. Authorized Official

Name: DR. GLENN A BROWN
Title or Position: PRESIDENT
Credential: DMD
Phone: 610-734-0666