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General NPI Number Information
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NPI Number | 1396585212
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Entity Type | Organization
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Legal Business Name | PHILADELPHIA SMILE CETER LLC
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 11911 BUSTLETON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19116-2541
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Country | US
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Telephone | 215-673-9050
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 OLD YORK RD
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City | ABINGTON
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State | PA
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Zip | 19001-1907
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Country | US
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Telephone | 215-558-4205
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Fax | 215-494-3603
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. KIRIL SHARKOV
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Credential |
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Telephone | 215-391-5939
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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 |
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License Number State |
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