1912353137 NPI number — EAGLE FAMILY SMILES PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912353137 NPI number — EAGLE FAMILY SMILES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAGLE FAMILY SMILES PC
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:
6
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:
1912353137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
74 POTTSTOWN PIKE STE 1001
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTER SPRINGS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19425-9569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-458-5165
Provider Business Mailing Address Fax Number:
610-514-2828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
74 POTTSTOWN PIKE STE 1001
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTER SPRINGS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19425-9569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-458-5165
Provider Business Practice Location Address Fax Number:
610-508-4917
Provider Enumeration Date:
05/06/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAKANI
Authorized Official First Name:
BHADRESH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-602-9373

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , 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)