Provider Demographics
NPI:1154566628
Name:BIG SMILES PENNSYLVANIA, PC
Entity type:Organization
Organization Name:BIG SMILES PENNSYLVANIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCHLANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:888-833-8441
Mailing Address - Street 1:33533 W 12 MILE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3354
Mailing Address - Country:US
Mailing Address - Phone:888-833-8441
Mailing Address - Fax:888-330-4331
Practice Address - Street 1:200 BARR HARBOR DR
Practice Address - Street 2:SUITE 400-4079
Practice Address - City:WEST CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2977
Practice Address - Country:US
Practice Address - Phone:888-833-8441
Practice Address - Fax:888-330-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037689122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty