Provider Demographics
NPI:1639496797
Name:SMILE PHILLY FAMILY & COSMETIC DENTISTRY, P.C.
Entity Type:Organization
Organization Name:SMILE PHILLY FAMILY & COSMETIC DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPA
Authorized Official - Middle Name:PATEL
Authorized Official - Last Name:FRABIZZIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-903-8597
Mailing Address - Street 1:6808 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-2146
Mailing Address - Country:US
Mailing Address - Phone:215-624-7418
Mailing Address - Fax:215-624-5499
Practice Address - Street 1:6808 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-2146
Practice Address - Country:US
Practice Address - Phone:215-624-7418
Practice Address - Fax:215-624-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035686122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty