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General NPI Number Information
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NPI Number | 1730550229
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Entity Type | Organization
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Legal Business Name | FRIENDLY SMILES ORTHODONTICS LLC
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 10/09/2015
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Provider Practice Location Address
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Address Line | 91 NEWPORT PIKE SUITE 304
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City | GAP
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State | PA
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Zip | 17527
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Country | US
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Telephone | 717-442-3639
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Fax | 717-442-4241
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Provider Business Mailing Address
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Address Line | 91 NEWPORT PIKE SUITE 304
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City | GAP
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State | PA
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Zip | 17527
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Country | US
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Telephone | 717-442-3639
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Fax | 717-442-4241
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. MAN YEE CHAN
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Credential | D.M.D.
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Telephone | 717-442-3639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DS039407
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License Number State | PA
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