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General NPI Number Information
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NPI Number | 1316389042
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Entity Type | Organization
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Legal Business Name | ABSOLUTE SMILE INC
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Dates
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Enumeration Date | 07/23/2013
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Last Update Date | 07/23/2013
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Provider Practice Location Address
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Address Line | 10100 JAMISON AVE 226
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City | PHILADELPHIA
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State | PA
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Zip | 19116-3832
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Country | US
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Telephone | 215-464-1704
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Fax |
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Provider Business Mailing Address
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Address Line | 10100 JAMISON AVE 226
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City | PHILADELPHIA
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State | PA
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Zip | 19116-3832
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Country | US
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Telephone | 215-464-1704
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Fax |
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Authorized Official
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Title or Position | OWNER/PTACTITIONER
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Name | BORIS FRIDMAN
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Credential |
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Telephone | 215-464-1704
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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 | DS031318-L
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License Number State | PA
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