Provider Demographics
NPI:1215263645
Name:ADVANCED DENTAL SMILES
Entity type:Organization
Organization Name:ADVANCED DENTAL SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JATIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOVALIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-237-1544
Mailing Address - Street 1:533 N YORK RD
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-2038
Mailing Address - Country:US
Mailing Address - Phone:215-672-9444
Mailing Address - Fax:215-672-9144
Practice Address - Street 1:533 N YORK RD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-2038
Practice Address - Country:US
Practice Address - Phone:215-672-9444
Practice Address - Fax:215-672-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty