Provider Demographics
NPI:1740880442
Name:SMILE MAKERS DENTISTRY PC
Entity type:Organization
Organization Name:SMILE MAKERS DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINKI
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-589-6084
Mailing Address - Street 1:45 TOLL GATE STA
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5687
Mailing Address - Country:US
Mailing Address - Phone:216-903-1762
Mailing Address - Fax:
Practice Address - Street 1:1192 W PENN AVE
Practice Address - Street 2:
Practice Address - City:WOMELSDORF
Practice Address - State:PA
Practice Address - Zip Code:19567-9702
Practice Address - Country:US
Practice Address - Phone:610-589-6084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty