Provider Demographics
NPI:1255896759
Name:SMILE DESIGNERS OF NORTH WALES PC
Entity type:Organization
Organization Name:SMILE DESIGNERS OF NORTH WALES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-699-0650
Mailing Address - Street 1:118 DICKERSON RD STE D
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-2538
Mailing Address - Country:US
Mailing Address - Phone:215-699-0650
Mailing Address - Fax:215-699-9599
Practice Address - Street 1:118 DICKERSON RD STE D
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-2538
Practice Address - Country:US
Practice Address - Phone:215-699-0650
Practice Address - Fax:215-699-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1598974115OtherNPI
PA1245769454OtherNPI