Provider Demographics
NPI:1033717020
Name:ALTA SMILES PA PC
Entity Type:Organization
Organization Name:ALTA SMILES PA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARKETING AND PROJECTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEMESH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-622-2653
Mailing Address - Street 1:1300 VIRGINIA DR STE 119
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3225
Mailing Address - Country:US
Mailing Address - Phone:215-622-2653
Mailing Address - Fax:
Practice Address - Street 1:700 S HENDERSON RD STE 306
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4208
Practice Address - Country:US
Practice Address - Phone:215-622-2653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty