Provider Demographics
NPI:1114264918
Name:SMILESTONE DENTAL OF NORTH WALES LLC
Entity Type:Organization
Organization Name:SMILESTONE DENTAL OF NORTH WALES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-822-1866
Mailing Address - Street 1:200 HIGHPOINT DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3925
Mailing Address - Country:US
Mailing Address - Phone:215-822-1866
Mailing Address - Fax:
Practice Address - Street 1:515 STUMP RD
Practice Address - Street 2:UNIT 205
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-1518
Practice Address - Country:US
Practice Address - Phone:215-822-1866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty