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General NPI Number Information
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NPI Number | 1093298325
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Entity Type | Organization
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Legal Business Name | FRIENDLY SMILE DENTAL INC
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Dates
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Enumeration Date | 09/12/2018
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Last Update Date | 09/12/2018
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Provider Practice Location Address
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Address Line | 7608 CASTOR AVE 1 ST FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19152
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Country | US
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Telephone | 215-725-1608
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Fax |
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Provider Business Mailing Address
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Address Line | 7608 CASTOR AVE FL 1
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City | PHILADELPHIA
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State | PA
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Zip | 19152-4024
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Country | US
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Telephone | 215-725-1608
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Fax |
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Authorized Official
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Title or Position | DMD
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Name | ANDREW MARINCHENKO
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Credential |
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Telephone | 267-752-8760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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