Provider Demographics
NPI:1396585212
Name:PHILADELPHIA SMILE CETER LLC
Entity type:Organization
Organization Name:PHILADELPHIA SMILE CETER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-391-5939
Mailing Address - Street 1:1501 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-1907
Mailing Address - Country:US
Mailing Address - Phone:215-558-4205
Mailing Address - Fax:215-494-3603
Practice Address - Street 1:11911 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-2541
Practice Address - Country:US
Practice Address - Phone:215-673-9050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty