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General NPI Number Information
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NPI Number | 1871746933
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Entity Type | Organization
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Legal Business Name | ANGEL SMILES PEDIATRIC DENTISTRY,P.C
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Dates
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Enumeration Date | 11/02/2008
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Last Update Date | 11/05/2008
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Provider Practice Location Address
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Address Line | 803 HEATHERSTONE DR
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City | BERWYN
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State | PA
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Zip | 19312-2506
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Country | US
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Telephone | 484-410-4557
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Fax |
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Provider Business Mailing Address
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Address Line | 803 HEATHERSTONE DR
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City | BERWYN
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State | PA
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Zip | 19312-2506
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Country | US
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Telephone | 484-410-4557
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | DR. SHURONG CAO
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Credential | DMD
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Telephone | 484-410-4557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS035020
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License Number State | PA
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