Provider Demographics
NPI:1275705584
Name:ABSOLUTE SMILE, INC
Entity Type:Organization
Organization Name:ABSOLUTE SMILE, INC
Other - Org Name:ABSOLUTE SMILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-331-7585
Mailing Address - Street 1:6737 HARBISON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-2342
Mailing Address - Country:US
Mailing Address - Phone:215-331-7585
Mailing Address - Fax:215-331-7589
Practice Address - Street 1:6737 HARBISON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2342
Practice Address - Country:US
Practice Address - Phone:215-331-7585
Practice Address - Fax:215-331-7589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031318-L1223G0001X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013063670004Medicaid