Provider Demographics
NPI:1881346427
Name:MY SMILE FOR LIFE
Entity type:Organization
Organization Name:MY SMILE FOR LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIJI
Authorized Official - Middle Name:
Authorized Official - Last Name:SEETHARAMN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-666-7415
Mailing Address - Street 1:6 KINGSLEY CT
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-2408
Mailing Address - Country:US
Mailing Address - Phone:732-666-7415
Mailing Address - Fax:
Practice Address - Street 1:9173 ROOSEVELT BLVD STE 22
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2234
Practice Address - Country:US
Practice Address - Phone:215-515-4797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental