Provider Demographics
NPI:1164005310
Name:SHEN SMILES
Entity Type:Organization
Organization Name:SHEN SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-956-9962
Mailing Address - Street 1:565 W PENN PIKE STE 1
Mailing Address - Street 2:
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-5673
Mailing Address - Country:US
Mailing Address - Phone:570-225-7498
Mailing Address - Fax:570-225-7495
Practice Address - Street 1:565 W PENN PIKE STE 1
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-5673
Practice Address - Country:US
Practice Address - Phone:570-225-7498
Practice Address - Fax:570-225-7495
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHEN SMILES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty