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General NPI Number Information
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NPI Number | 1740767458
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Entity Type | Organization
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Legal Business Name | LEGENDARY SMILES PC
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Dates
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Enumeration Date | 07/25/2018
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Last Update Date | 07/25/2018
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Provider Practice Location Address
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Address Line | 1330 W CHESTER PIKE
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City | HAVERTOWN
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State | PA
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Zip | 19083-3246
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Country | US
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Telephone | 610-789-4040
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Fax |
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Provider Business Mailing Address
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Address Line | 1330 W CHESTER PIKE
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City | HAVERTOWN
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State | PA
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Zip | 19083-3246
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Country | US
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Telephone | 610-789-4040
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Fax |
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | MEETU SINGH
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Credential |
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Telephone | 610-717-4212
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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 | DS038087
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License Number State | PA
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