Provider Demographics
NPI:1992180103
Name:A PERFECT SMILE, PC
Entity Type:Organization
Organization Name:A PERFECT SMILE, PC
Other - Org Name:A PERFECT SMILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PANOSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:610-254-5081
Mailing Address - Street 1:290 KING OF PRUSSIA RD
Mailing Address - Street 2:BUILDING 1, SUITE 310
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5107
Mailing Address - Country:US
Mailing Address - Phone:610-780-5179
Mailing Address - Fax:
Practice Address - Street 1:4 ROCKBOURNE RD
Practice Address - Street 2:
Practice Address - City:CLIFTON HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:19018-1722
Practice Address - Country:US
Practice Address - Phone:610-254-5081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA122300000X
PADS0362771223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty