Provider Demographics
NPI:1285936195
Name:SMILE MAKERS, PC
Entity type:Organization
Organization Name:SMILE MAKERS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:GHADAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-633-2109
Mailing Address - Street 1:1192 W. PENN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WOMELSDORF
Mailing Address - State:PA
Mailing Address - Zip Code:19567
Mailing Address - Country:US
Mailing Address - Phone:610-589-6084
Mailing Address - Fax:610-589-6284
Practice Address - Street 1:1192 W PENN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:WOMELSDORF
Practice Address - State:PA
Practice Address - Zip Code:19567-9702
Practice Address - Country:US
Practice Address - Phone:610-589-6084
Practice Address - Fax:610-589-6284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0381261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA241411041OtherTAX ID