MEDICARE: ARTISTIC SMILE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1447869235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARTISTIC SMILE LLC

Provider Business Mailing Address
First Line	:	2801 ISLAND AVE STE 5
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19153-2326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 ISLAND AVE STE 5
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19153-2326
Country	:	US
Telephone Number	:	215-492-0702
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. IRENE MENDES
Credential	:
Telephone Number	:	215-492-0702

Provider Enumeration Date	:	07/28/2020
Last Update Date	:	07/28/2020

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Directions to “ARTISTIC SMILE LLC ” Practice Location

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