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General NPI Number Information
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NPI Number | 1467931790
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Entity Type | Organization
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Legal Business Name | SEA OF SMILES 3PLLC
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 1501 MAIN ST STE 240
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City | WARRINGTON
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State | PA
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Zip | 18976-3400
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Country | US
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Telephone | 215-433-1835
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Fax | 412-317-1568
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Provider Business Mailing Address
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Address Line | 301 OXFORD VALLEY ROAD SUITE 1801
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City | YARDLEY
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State | PA
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Zip | 19067
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Country | US
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Telephone | 267-392-5878
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Fax | 412-317-1568
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Authorized Official
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Title or Position | DENTIST
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Name | RAJ PATEL
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Credential | DMD
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Telephone | 267-392-5878
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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 | DS038462
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License Number State | PA
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