Provider Demographics
NPI:1316389042
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/PTACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-464-1704
Mailing Address - Street 1:10100 JAMISON AVE
Mailing Address - Street 2:226
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3832
Mailing Address - Country:US
Mailing Address - Phone:215-464-1704
Mailing Address - Fax:
Practice Address - Street 1:10100 JAMISON AVE
Practice Address - Street 2:226
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3832
Practice Address - Country:US
Practice Address - Phone:215-464-1704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031318-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty