Provider Demographics
NPI:1992192728
Name:ADVANCED SMILES PC
Entity Type:Organization
Organization Name:ADVANCED SMILES PC
Other - Org Name:ADVANCED SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANCU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-788-4918
Mailing Address - Street 1:1118 STATE RD
Mailing Address - Street 2:
Mailing Address - City:CROYDON
Mailing Address - State:PA
Mailing Address - Zip Code:19021-6123
Mailing Address - Country:US
Mailing Address - Phone:215-788-4918
Mailing Address - Fax:
Practice Address - Street 1:1118 STATE RD
Practice Address - Street 2:
Practice Address - City:CROYDON
Practice Address - State:PA
Practice Address - Zip Code:19021-6123
Practice Address - Country:US
Practice Address - Phone:215-788-4918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty