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General NPI Number Information
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NPI Number | 1821556721
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Entity Type | Organization
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Legal Business Name | SMILE AGAIN PROGRAM, PC
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Dates
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Enumeration Date | 03/10/2019
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Last Update Date | 03/10/2019
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Provider Practice Location Address
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Address Line | 450 N NARBERTH AVE STE 200
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City | NARBERTH
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State | PA
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Zip | 19072-1822
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Country | US
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Telephone | 215-815-0130
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Fax |
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Provider Business Mailing Address
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Address Line | 450 N NARBERTH AVE STE 200
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City | NARBERTH
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State | PA
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Zip | 19072-1822
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Country | US
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Telephone | 215-815-0130
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK S GOLDSTEIN
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Credential | DDS
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Telephone | 215-815-0130
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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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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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