Provider Demographics
NPI:1124642897
Name:WALNUT STREET SMILES PC
Entity type:Organization
Organization Name:WALNUT STREET SMILES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:HAMILTON
Authorized Official - Last Name:SCHREINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-804-3738
Mailing Address - Street 1:1601 WALNUT ST STE 1025
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2911
Mailing Address - Country:US
Mailing Address - Phone:215-564-1025
Mailing Address - Fax:
Practice Address - Street 1:1601 WALNUT ST STE 1025
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2911
Practice Address - Country:US
Practice Address - Phone:215-564-1025
Practice Address - Fax:215-564-1027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental