1861712853 NPI number — DESIGNER SMILES DENTISTRY, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861712853 NPI number — DESIGNER SMILES DENTISTRY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DESIGNER SMILES DENTISTRY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DESIGNER SMILES DENTISTRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861712853
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
585 STEWART AVE
Provider Second Line Business Mailing Address:
SUITE LL28
Provider Business Mailing Address City Name:
GARDEN CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11530-4783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-280-4020
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
585 STEWART AVE
Provider Second Line Business Practice Location Address:
SUITE LL28
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11530-4783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-280-4020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HSIEH
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
W
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
646-339-8606

Provider Taxonomy Codes

  • Taxonomy code: 1223P0700X , with the licence number:  050272 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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