Healthcare Provider Details

I. General information

NPI: 1992631915
Provider Name (Legal Business Name): SMILE CENTER OF WYNCOTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EASTON RD STE 315
WYNCOTE PA
19095-2900
US

IV. Provider business mailing address

1000 EASTON RD STE 315
WYNCOTE PA
19095-2900
US

V. Phone/Fax

Practice location:
  • Phone: 267-631-1000
  • Fax: 267-820-8160
Mailing address:
  • Phone: 267-631-1000
  • 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: KIRIL SHARKOV
Title or Position: DIRECTOR
Credential:
Phone: 215-391-5939