Provider Demographics
NPI:1093298325
Name:FRIENDLY SMILE DENTAL INC
Entity Type:Organization
Organization Name:FRIENDLY SMILE DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-752-8760
Mailing Address - Street 1:7608 CASTOR AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-4024
Mailing Address - Country:US
Mailing Address - Phone:215-725-1608
Mailing Address - Fax:
Practice Address - Street 1:7608 CASTOR AVE 1 ST FLOOR
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152
Practice Address - Country:US
Practice Address - Phone:215-725-1608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental