Provider Demographics
NPI:1417612573
Name:SMILEHAUS PEDIATRIC DENTISTRY, PLLC
Entity Type:Organization
Organization Name:SMILEHAUS PEDIATRIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODOOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:717-589-4500
Mailing Address - Street 1:417 OLD FARM LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-4117
Mailing Address - Country:US
Mailing Address - Phone:571-225-7921
Mailing Address - Fax:
Practice Address - Street 1:200 BENT CREEK BLVD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1938
Practice Address - Country:US
Practice Address - Phone:717-589-4500
Practice Address - Fax:717-207-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty