Provider Demographics
NPI:1942317532
Name:SMILE PENNSYLVANIA PLLC
Entity Type:Organization
Organization Name:SMILE PENNSYLVANIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:YELLIN
Authorized Official - Last Name:WOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:888-833-8441
Mailing Address - Street 1:PO BOX 250310
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-0310
Mailing Address - Country:US
Mailing Address - Phone:888-833-8441
Mailing Address - Fax:888-330-4331
Practice Address - Street 1:200 BARR HARBOR DR
Practice Address - Street 2:SUITE 400-4079
Practice Address - City:WEST CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2977
Practice Address - Country:US
Practice Address - Phone:888-833-8441
Practice Address - Fax:888-330-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015239590001Medicaid