Organization
KIDS SMILES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NONI MASTRA (FINANCIAL DIRECTOR)
(215) 747-6901
Entity
Organization
Contact information
Practice address
5828 MARKET ST # B, PHILADELPHIA, PA 19139-3114
(215) 747-6901
(215) 747-6907
Mailing address
5828 MARKET ST # B, PHILADELPHIA, PA 19139-3114
(215) 747-6901
(215) 747-6907
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS021445L
PA
1223G0001X
General Practice Dentistry
DS036815
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018280190002
—
PA
Enumeration date
02/09/2007
Last updated
08/22/2020
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