Provider Demographics
NPI:1912353137
Name:EAGLE FAMILY SMILES PC
Entity Type:Organization
Organization Name:EAGLE FAMILY SMILES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BHADRESH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-602-9373
Mailing Address - Street 1:72 POTTSTOWN PIKE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-9564
Mailing Address - Country:US
Mailing Address - Phone:610-458-5165
Mailing Address - Fax:610-514-2828
Practice Address - Street 1:72 POTTSTOWN PIKE
Practice Address - Street 2:SUITE 103
Practice Address - City:CHESTER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:19425-9564
Practice Address - Country:US
Practice Address - Phone:610-458-5165
Practice Address - Fax:610-514-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental