Provider Demographics
NPI:1386275642
Name:LASTING SMILES OF WILLOWGROVE LLC
Entity type:Organization
Organization Name:LASTING SMILES OF WILLOWGROVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHANDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHADHA
Authorized Official - Suffix:
Authorized Official - Credentials:DENTIST
Authorized Official - Phone:516-749-3163
Mailing Address - Street 1:35 YORK RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-3419
Mailing Address - Country:US
Mailing Address - Phone:215-366-5678
Mailing Address - Fax:215-346-2672
Practice Address - Street 1:35 YORK RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-3419
Practice Address - Country:US
Practice Address - Phone:215-366-5678
Practice Address - Fax:215-346-2672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty