Provider Demographics
NPI:1790425007
Name:SMILEON FAMILY DENTISTRY
Entity type:Organization
Organization Name:SMILEON FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANUSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMMU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:571-385-6646
Mailing Address - Street 1:185 SPRING MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:17345-9485
Mailing Address - Country:US
Mailing Address - Phone:571-385-6646
Mailing Address - Fax:
Practice Address - Street 1:75 MALL RD
Practice Address - Street 2:
Practice Address - City:ETTERS
Practice Address - State:PA
Practice Address - Zip Code:17319-9500
Practice Address - Country:US
Practice Address - Phone:717-938-5757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty