NPIMap

Organization Active NPI

Smile Line Dental

  • General Practice Dentistry
  • Philadelphia, PA
National Provider Identifier
1609171388
Registry record updated Jan 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS-036185 Issued in PA
Legal business name
SMILE LINE DENTAL
Practice address
8115 Ridge Ave
Philadelphia, PA 19128-2901
Phone
(215) 487-2347
Fax
(215) 487-1459
NPI assigned
Jan 11, 2011
Last updated
Jan 11, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Sung Joo Jeong, D.D.S.
Title
Owner
Phone
(610) 828-1666

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DS-036185 PA Primary

Addresses

Primary practice location

8115 Ridge Ave
Philadelphia, PA 19128-2901

Mailing address

8115 Ridge Ave
Philadelphia, PA 19128-2901
Phone (215) 487-2347

National Provider Directory

National Provider Directory
Tax ID family
Smile Line Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8115 Ridge Ave
Philadelphia, PA 19128
Phone (215) 487-2347

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294704000000",
    "number": "1609171388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8115 RIDGE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191282901",
            "telephone_number": "215-487-2347",
            "fax_number": "215-487-1459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8115 RIDGE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191282901",
            "telephone_number": "215-487-2347",
            "fax_number": "215-487-1459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILE LINE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-11",
        "last_updated": "2011-01-11",
        "status": "A",
        "authorized_official_last_name": "JEONG",
        "authorized_official_first_name": "SUNG JOO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-828-1666",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS-036185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.