Provider Demographics
NPI:1013745033
Name:SMILE DOCTORS OF PENNSYLVANIA, P.C.
Entity type:Organization
Organization Name:SMILE DOCTORS OF PENNSYLVANIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:G
Authorized Official - Last Name:GOGGANS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:719-569-5715
Mailing Address - Street 1:5400 LBJ FWY STE 800
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-1058
Mailing Address - Country:US
Mailing Address - Phone:719-252-1860
Mailing Address - Fax:
Practice Address - Street 1:1605 N CEDAR CREST BLVD STE 519
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2389
Practice Address - Country:US
Practice Address - Phone:610-435-2788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty