Provider Demographics
NPI:1427218882
Name:ABSOLUTE SMILE
Entity Type:Organization
Organization Name:ABSOLUTE SMILE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAIN RECEPTIONIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:OLESYA
Authorized Official - Middle Name:I
Authorized Official - Last Name:TRIKUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-355-4007
Mailing Address - Street 1:1045 STREET RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4232
Mailing Address - Country:US
Mailing Address - Phone:215-355-4007
Mailing Address - Fax:215-355-4008
Practice Address - Street 1:1045 STREET RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4232
Practice Address - Country:US
Practice Address - Phone:215-355-4007
Practice Address - Fax:215-355-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty