Provider Demographics
NPI:1811594724
Name:BETHLEHEM SMILE DESIGN LLC
Entity Type:Organization
Organization Name:BETHLEHEM SMILE DESIGN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BHAUMIK
Authorized Official - Middle Name:
Authorized Official - Last Name:KANANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-446-5662
Mailing Address - Street 1:315 E ETTWEIN ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-4130
Mailing Address - Country:US
Mailing Address - Phone:610-849-2042
Mailing Address - Fax:610-849-2038
Practice Address - Street 1:315 E ETTWEIN ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-4130
Practice Address - Country:US
Practice Address - Phone:610-849-2042
Practice Address - Fax:610-849-2038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty