Provider Demographics
NPI:1336688712
Name:SMEDLEY ORTHODONTICS LTD
Entity Type:Organization
Organization Name:SMEDLEY ORTHODONTICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMEDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-269-6065
Mailing Address - Street 1:797 E LANCASTER AVE # D
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3315
Mailing Address - Country:US
Mailing Address - Phone:610-269-6065
Mailing Address - Fax:610-269-3578
Practice Address - Street 1:797-D EAST LANCASTER AVENUE
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3315
Practice Address - Country:US
Practice Address - Phone:610-269-6065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0179201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027671260001Medicaid