Provider Demographics
NPI:1679287676
Name:FRESH SMILES PLLC
Entity Type:Organization
Organization Name:FRESH SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:SHEA
Authorized Official - Last Name:BOWER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-433-6714
Mailing Address - Street 1:140 W GERMANTOWN PIKE STE 150
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1434
Mailing Address - Country:US
Mailing Address - Phone:484-531-7410
Mailing Address - Fax:484-532-8222
Practice Address - Street 1:140 W GERMANTOWN PIKE STE 150
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1434
Practice Address - Country:US
Practice Address - Phone:484-531-7410
Practice Address - Fax:484-532-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental