Provider Demographics
NPI:1730550229
Name:FRIENDLY SMILES ORTHODONTICS LLC
Entity type:Organization
Organization Name:FRIENDLY SMILES ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAN YEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-442-3639
Mailing Address - Street 1:91 NEWPORT PIKE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:GAP
Mailing Address - State:PA
Mailing Address - Zip Code:17527
Mailing Address - Country:US
Mailing Address - Phone:717-442-3639
Mailing Address - Fax:717-442-4241
Practice Address - Street 1:91 NEWPORT PIKE
Practice Address - Street 2:SUITE 304
Practice Address - City:GAP
Practice Address - State:PA
Practice Address - Zip Code:17527
Practice Address - Country:US
Practice Address - Phone:717-442-3639
Practice Address - Fax:717-442-4241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0394071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty