Provider Demographics
NPI:1407180474
Name:PRECIOUS SMILES INC
Entity Type:Organization
Organization Name:PRECIOUS SMILES INC
Other - Org Name:PRECIOUS SMILES FAMILY & IMPLANT DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-771-1076
Mailing Address - Street 1:338 STEELE RD
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-4548
Mailing Address - Country:US
Mailing Address - Phone:215-364-2348
Mailing Address - Fax:215-364-2348
Practice Address - Street 1:4201 NESHAMINY BLVD
Practice Address - Street 2:SUITE 117
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-1609
Practice Address - Country:US
Practice Address - Phone:215-364-2348
Practice Address - Fax:215-364-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0361321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty