Smile Defenders LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SMILE DEFENDERS LLC

Practice address

3117 Kensington Ave
Philadelphia, PA 19134-2420

Phone

(215) 454-6640

Fax

(215) 454-6641

NPI assigned

Jan 27, 2021

Organization subpart

No

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

Authorized official

Name

Miss Valerie L Andruchiw

Title

Director

Phone

(215) 454-6640

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1611705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611705600000",
    "number": "1891386413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3117 KENSINGTON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191342420",
            "telephone_number": "215-454-6640",
            "fax_number": "215-454-6641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3117 KENSINGTON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191342420",
            "telephone_number": "215-454-6640",
            "fax_number": "215-454-6641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILE DEFENDERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-27",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A",
        "authorized_official_last_name": "ANDRUCHIW",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "215-454-6640",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Smile District LLC
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• Smile Line Dental

• General Practice Dentistry in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; 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.