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General NPI Number Information
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NPI Number | 1124662911
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Entity Type | Organization
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Legal Business Name | SMILES GROUP LLC
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Dates
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Enumeration Date | 11/05/2019
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 7 W WINONA AVE
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City | NORWOOD
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State | PA
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Zip | 19074-1403
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Country | US
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Telephone | 302-290-0313
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Fax |
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Provider Business Mailing Address
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Address Line | 959 NAAMANS CREEK RD
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City | CHADDS FORD
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State | PA
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Zip | 19317-9049
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Country | US
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Telephone | 302-438-4063
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SRUJANA ELURI
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Credential |
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Telephone | 302-438-4063
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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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