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General NPI Number Information
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NPI Number | 1215375365
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Entity Type | Organization
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Legal Business Name | SMILE KRAFTERS PEDIATRIC, LLC
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Dates
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Enumeration Date | 06/11/2013
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Last Update Date | 06/11/2013
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Provider Practice Location Address
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Address Line | 1247 S CEDAR CREST BLVD
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City | ALLENTOWN
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State | PA
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Zip | 18103-6298
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Country | US
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Telephone | 610-628-1228
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Fax |
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Provider Business Mailing Address
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Address Line | 1247 S CEDAR CREST BLVD
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City | ALLENTOWN
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State | PA
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Zip | 18103-6298
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Country | US
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Telephone | 610-628-1228
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW DORMESHIAN
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Credential |
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Telephone | 917-847-6976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS036490
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License Number State | PA
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