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General NPI Number Information
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NPI Number | 1265838379
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Entity Type | Organization
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Legal Business Name | WALLINGFORD SMILEMAKERS LLC
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 1 CHESTER RD
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City | WALLINGFORD
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State | PA
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Zip | 19086-6601
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Country | US
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Telephone | 610-874-5700
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Fax | 610-872-5348
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Provider Business Mailing Address
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Address Line | 1 CHESTER RD
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City | WALLINGFORD
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State | PA
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Zip | 19086-6601
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Country | US
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Telephone | 610-874-5700
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Fax | 610-872-5348
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. RONALD MICHAEL HAYES
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Credential | DMD
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Telephone | 610-874-5700
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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 | DS028517L
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License Number State | PA
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