Provider Demographics
NPI:1174994941
Name:ADVANCE SMILE DENTAL CREATOR LLC
Entity type:Organization
Organization Name:ADVANCE SMILE DENTAL CREATOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HARESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:NADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-837-3424
Mailing Address - Street 1:927 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-2021
Mailing Address - Country:US
Mailing Address - Phone:610-965-2755
Mailing Address - Fax:610-965-2755
Practice Address - Street 1:927 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-2021
Practice Address - Country:US
Practice Address - Phone:610-965-2755
Practice Address - Fax:610-965-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty