# KIDS SMILES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326189820
- **Authorized official:** NONI MASTRA (FINANCIAL DIRECTOR)
- **Authorized official phone:** (215) 492-9291

## Contact information

- **Practice address:** 2821 ISLAND AVE, SUITE 210, PHILADELPHIA, PA 19153-2300
- **Practice address phone:** (215) 492-9291
- **Practice address fax:** (215) 492-5856
- **Mailing address:** 2821 ISLAND AVE, SUITE 210, PHILADELPHIA, PA 19153-2300
- **Mailing address phone:** (215) 492-9291
- **Mailing address fax:** (215) 492-5856

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DS035389 | PA | Yes |
| 1223G0001X | General Practice Dentistry | DS035558 | PA | — |
| 1223P0221X | Pediatric Dentistry | — | PA | — |

## Other

- **Enumeration date:** 02/09/2007
- **Last updated:** 05/10/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0018280190001 | — | PA |