Provider Demographics
NPI:1225432230
Name:ART OF SMILE CENTER FOR COSMETIC ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:ART OF SMILE CENTER FOR COSMETIC ORTHODONTICS, LLC
Other - Org Name:ART OF SMILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-800-0015
Mailing Address - Street 1:2 FRANKLIN TOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1238
Mailing Address - Country:US
Mailing Address - Phone:215-800-0015
Mailing Address - Fax:
Practice Address - Street 1:2 FRANKLIN TOWN BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1238
Practice Address - Country:US
Practice Address - Phone:215-800-0015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029110L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1043397755OtherINDIVIDUAL NPI