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General NPI Number Information
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NPI Number | 1194127738
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Entity Type | Organization
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Legal Business Name | ART OF SMILE
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Dates
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Enumeration Date | 09/25/2014
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 8332 BUSTLETON AVE UNIT C
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City | PHILADELPHIA
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State | PA
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Zip | 19152-1909
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Country | US
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Telephone | 215-342-9000
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Fax | 215-342-9100
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Provider Business Mailing Address
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Address Line | PO BOX 6104
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City | PHILADELPHIA
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State | PA
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Zip | 19115-6104
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Country | US
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Telephone | 215-342-9000
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Fax | 215-342-9100
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Authorized Official
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Title or Position | PRESIDENT
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Name | SVETLANA KUTOVOY
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Credential |
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Telephone | 215-342-9000
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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 | DS020408L
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License Number State | PA
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