Basic Information
| Provider Information | |||||||||
| NPI: | 1174110498 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SMILE CENTER DENTAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3950 NEBRASKA AVE STE C1 | ||||||||
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| City: | LEVITTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190563375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157851100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2900 14TH ST NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200096863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028470567 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2020 | ||||||||
| LastUpdateDate: | 12/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ARORA | ||||||||
| AuthorizedOfficialFirstName: | VIKAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2157851100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.