Healthcare Provider Details

I. General information

NPI: 1740880442
Provider Name (Legal Business Name): SMILE MAKERS DENTISTRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 10/30/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1192 W PENN AVE
WOMELSDORF PA
19567-9702
US

IV. Provider business mailing address

45 TOLL GATE STA
LANCASTER PA
17601-5687
US

V. Phone/Fax

Practice location:
  • Phone: 610-589-6084
  • Fax:
Mailing address:
  • Phone: 216-903-1762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MINKI JUNG
Title or Position: OWNER
Credential: DMD
Phone: 610-589-6084