Provider Demographics
NPI:1679795330
Name:SMOLOW, MITCHELL ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:ALAN
Last Name:SMOLOW
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-9527
Mailing Address - Country:US
Mailing Address - Phone:570-714-4000
Mailing Address - Fax:570-696-3320
Practice Address - Street 1:720 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:SHAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18708-9527
Practice Address - Country:US
Practice Address - Phone:570-714-4000
Practice Address - Fax:570-696-3320
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020248L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry