Organization
KIDS SMILES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NONI MASTRA (FINANCIAL DIRECTOR)
(215) 492-9291
Entity
Organization
Contact information
Practice address
2821 ISLAND AVE, SUITE 210, PHILADELPHIA, PA 19153-2300
(215) 492-9291
(215) 492-5856
Mailing address
2821 ISLAND AVE, SUITE 210, PHILADELPHIA, PA 19153-2300
(215) 492-9291
(215) 492-5856
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS035389
PA
1223G0001X
General Practice Dentistry
DS035558
PA
1223P0221X
Pediatric Dentistry
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018280190001
—
PA
Enumeration date
02/09/2007
Last updated
05/10/2012
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