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General NPI Number Information
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NPI Number | 1851014864
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Entity Type | Organization
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Legal Business Name | PRISTINE SMILES FAMILY DENTISTRY
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 219 E MAIN ST STE 113
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City | MECHANICSBURG
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State | PA
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Zip | 17055-6541
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Country | US
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Telephone | 717-790-2184
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Fax |
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Provider Business Mailing Address
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Address Line | 219 E MAIN ST STE 113
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City | MECHANICSBURG
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State | PA
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Zip | 17055-6541
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Country | US
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Telephone | 717-790-2184
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | NANDHINI BOGAVELLI
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Credential |
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Telephone | 717-790-2184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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