Provider Demographics
NPI:1114386513
Name:PERFECT SMILE DENTAL GROUP PC
Entity Type:Organization
Organization Name:PERFECT SMILE DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PENG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-942-4699
Mailing Address - Street 1:125 E PLEASANT VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-5544
Mailing Address - Country:US
Mailing Address - Phone:814-942-4699
Mailing Address - Fax:814-942-4587
Practice Address - Street 1:29 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-837-3911
Practice Address - Fax:724-837-7511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERFECT SMILE DENTAL GROUP PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-15
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0382781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty