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General NPI Number Information
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NPI Number | 1811594724
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Entity Type | Organization
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Legal Business Name | BETHLEHEM SMILE DESIGN LLC
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Dates
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Enumeration Date | 10/04/2020
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Last Update Date | 10/04/2020
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Provider Practice Location Address
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Address Line | 315 E ETTWEIN ST
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City | BETHLEHEM
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State | PA
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Zip | 18018-4130
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Country | US
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Telephone | 610-849-2042
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Fax | 610-849-2038
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Provider Business Mailing Address
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Address Line | 315 E ETTWEIN ST
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City | BETHLEHEM
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State | PA
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Zip | 18018-4130
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Country | US
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Telephone | 610-849-2042
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Fax | 610-849-2038
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Authorized Official
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Title or Position | MANAGER
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Name | BHAUMIK KANANI
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Credential |
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Telephone | 213-446-5662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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