MEDICARE: SMILE TEAM

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	:	1871267054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE TEAM

Provider Business Mailing Address
First Line	:	19 SIMSBURY DR
Second Line	:
City	:	VOORHEES
State	:	NJ
Zip	:	08043-3948
Country	:	US
Telephone Number	:	732-789-3811
Fax Number	:	215-709-6002

Provider Business Practice Location Address
First Line	:	410 LONG LN
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-5112
Country	:	US
Telephone Number	:	215-709-0001
Fax Number	:	215-709-6002

Authorized Official
Title or Position	:	OWNER
Name	:	BANSI DOESCHER
Credential	:
Telephone Number	:	732-789-3811

Provider Enumeration Date	:	08/02/2021
Last Update Date	:	08/02/2021

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Directions to “SMILE TEAM ” Practice Location

Language	Start Address	Practice Location

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