Provider Demographics
NPI:1851161129
Name:SOUTHAMPTON DENTAL SMILES
Entity Type:Organization
Organization Name:SOUTHAMPTON DENTAL SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-431-6207
Mailing Address - Street 1:626 STREET RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3754
Mailing Address - Country:US
Mailing Address - Phone:215-953-6626
Mailing Address - Fax:215-953-6627
Practice Address - Street 1:626 STREET RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3754
Practice Address - Country:US
Practice Address - Phone:215-953-6626
Practice Address - Fax:215-953-6627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty