Smile for Life PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SMILE FOR LIFE PC

Practice address

9173 Roosevelt Blvd SPC 22
Philadelphia, PA 19114-2204

Phone

(215) 515-4797

NPI assigned

Jul 18, 2019

Organization subpart

No

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

Authorized official

Name

Nino Taboridze

Title

Manager

Phone

(215) 552-9800

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Yage Wu, DDS

  • General Practice Dentistry
  • Philadelphia, PA
  • NPI 1811452428
  NPD

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

{
    "created_epoch": "1563408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565136000000",
    "number": "1902459902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9173 ROOSEVELT BLVD SPC 22",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191142204",
            "telephone_number": "215-515-4797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9173 ROOSEVELT BLVD SPC 22",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191142204",
            "telephone_number": "215-515-4797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILE FOR LIFE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-18",
        "last_updated": "2019-08-07",
        "status": "A",
        "authorized_official_last_name": "TABORIDZE",
        "authorized_official_first_name": "NINO",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "215-552-9800"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "philadelphia",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "9173 Roosevelt Blvd Spc 22",
            "city": "Philadelphia",
            "state": "PA",
            "country_code": "US",
            "postal_code": "191142204",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Smile Center on Roosevelt LLC
• Smile Defenders LLC
• Smile Designers Dental Center, LLC
• Smile Designers LLC
• Smile District LLC
• Smile Line Dental
• Smile Philly Family & Cosmetic Dentistry, P.C.
• Smile Team PC
• Smile Team PC
• Smile Team PC

• 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 Aug 7, 2019; 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.