Provider Demographics
NPI:1891386413
Name:SMILE DEFENDERS LLC
Entity Type:Organization
Organization Name:SMILE DEFENDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDRUCHIW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-454-6640
Mailing Address - Street 1:3117 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-2420
Mailing Address - Country:US
Mailing Address - Phone:215-454-6640
Mailing Address - Fax:215-454-6641
Practice Address - Street 1:3117 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-2420
Practice Address - Country:US
Practice Address - Phone:215-454-6640
Practice Address - Fax:215-454-6641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty