Provider Demographics
NPI:1215408588
Name:CCD PERFECT SMILES, LLC
Entity Type:Organization
Organization Name:CCD PERFECT SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-842-5421
Mailing Address - Street 1:2406 BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-6002
Mailing Address - Country:US
Mailing Address - Phone:215-752-5911
Mailing Address - Fax:215-702-7666
Practice Address - Street 1:2406 BRISTOL RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-6002
Practice Address - Country:US
Practice Address - Phone:215-752-5911
Practice Address - Fax:215-702-7666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty