Provider Demographics
NPI:1548565716
Name:SMILE LINE DENTAL
Entity Type:Organization
Organization Name:SMILE LINE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNG JOO
Authorized Official - Middle Name:
Authorized Official - Last Name:JEONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-828-1666
Mailing Address - Street 1:625 N CHARLOTTE ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-4645
Mailing Address - Country:US
Mailing Address - Phone:610-906-3389
Mailing Address - Fax:610-828-1666
Practice Address - Street 1:625 N CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-4645
Practice Address - Country:US
Practice Address - Phone:610-906-3389
Practice Address - Fax:610-828-1666
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMILE LINE DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-0361851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty