Provider Demographics
NPI:1942892377
Name:IDEAL SMILE OF EXTON
Entity Type:Organization
Organization Name:IDEAL SMILE OF EXTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALUYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-666-5789
Mailing Address - Street 1:1650 MEETINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-1034
Mailing Address - Country:US
Mailing Address - Phone:171-866-6578
Mailing Address - Fax:
Practice Address - Street 1:356 N POTTSTOWN PIKE STE 100
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2246
Practice Address - Country:US
Practice Address - Phone:718-666-5789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty