Provider Demographics
NPI:1073216214
Name:PURE SMILE DENTISTRY
Entity Type:Organization
Organization Name:PURE SMILE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EUN HYE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-893-1973
Mailing Address - Street 1:981 N WALES RD STE 7
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1422
Mailing Address - Country:US
Mailing Address - Phone:240-893-1973
Mailing Address - Fax:
Practice Address - Street 1:981 N WALES RD STE 7
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-1422
Practice Address - Country:US
Practice Address - Phone:240-893-1973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty