1467931790 NPI number — SEA OF SMILES 3PLLC

Table of content: (NPI 1467931790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467931790 NPI number — SEA OF SMILES 3PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEA OF SMILES 3PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467931790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 OXFORD VALLEY ROAD
Provider Second Line Business Mailing Address:
SUITE 1801
Provider Business Mailing Address City Name:
YARDLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-392-5878
Provider Business Mailing Address Fax Number:
412-317-1568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 MAIN ST STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18976-3400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-433-1835
Provider Business Practice Location Address Fax Number:
412-317-1568
Provider Enumeration Date:
08/08/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
RAJ
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
267-392-5878

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  DS038462 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)