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General NPI Number Information
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NPI Number | 1871267054
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Entity Type | Organization
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Legal Business Name | SMILE TEAM
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Dates
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Enumeration Date | 08/02/2021
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 410 LONG LN
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City | UPPER DARBY
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State | PA
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Zip | 19082-5112
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Country | US
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Telephone | 215-709-0001
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Fax | 215-709-6002
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Provider Business Mailing Address
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Address Line | 19 SIMSBURY DR
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City | VOORHEES
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State | NJ
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Zip | 08043-3948
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Country | US
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Telephone | 732-789-3811
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Fax | 215-709-6002
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Authorized Official
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Title or Position | OWNER
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Name | BANSI DOESCHER
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Credential |
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Telephone | 732-789-3811
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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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