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Organization
SMILE FOR LIFE PC
Active
Organization
SMILE FOR LIFE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NINO TABORIDZE (MANAGER)
(215) 552-9800
Entity
Organization
Contact information
Practice address
9173 ROOSEVELT BLVD SPC 22, PHILADELPHIA, PA 19114-2204
(215) 515-4797
Mailing address
9173 ROOSEVELT BLVD SPC 22, PHILADELPHIA, PA 19114-2204
(215) 515-4797
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/18/2019
Last updated
08/07/2019
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