Provider Demographics
NPI:1871267054
Name:SMILE TEAM
Entity Type:Organization
Organization Name:SMILE TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BANSI
Authorized Official - Middle Name:
Authorized Official - Last Name:DOESCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-789-3811
Mailing Address - Street 1:19 SIMSBURY DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3948
Mailing Address - Country:US
Mailing Address - Phone:732-789-3811
Mailing Address - Fax:215-709-6002
Practice Address - Street 1:410 LONG LN
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-5112
Practice Address - Country:US
Practice Address - Phone:215-709-0001
Practice Address - Fax:215-709-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty