Provider Demographics
NPI:1477833895
Name:KIDS AND ADULT SMILES
Entity Type:Organization
Organization Name:KIDS AND ADULT SMILES
Other - Org Name:DENT-AL SMILES OF ALTOONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PENG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-942-4699
Mailing Address - Street 1:125 EAST PLEASANT VALLEY BLVD.
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-5544
Mailing Address - Country:US
Mailing Address - Phone:814-942-4699
Mailing Address - Fax:814-942-4587
Practice Address - Street 1:125 EAST PLEASANT VALLEY BLVD.
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5544
Practice Address - Country:US
Practice Address - Phone:814-942-4699
Practice Address - Fax:814-942-4587
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIDS AND ADULT SMILES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-17
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty