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General NPI Number Information
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NPI Number | 1154717825
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Entity Type | Organization
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Legal Business Name | SMILE BRIGHT DENTAL
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 2102 S BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19145-3960
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Country | US
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Telephone | 267-388-0998
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Fax | 215-689-4687
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Provider Business Mailing Address
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Address Line | 2102 S BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19145-3960
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Country | US
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Telephone | 267-388-0998
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Fax | 215-689-4687
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Authorized Official
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Title or Position | DENTIST
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Name | DR. LEON AIRE WERTHEIMER
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Credential | DDS
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Telephone | 267-388-0998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS019271L
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License Number State | PA
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