1548771645 NPI number — SMILES 4 A LIFETIME DENTAL PLLC

Table of content: (NPI 1548771645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548771645 NPI number — SMILES 4 A LIFETIME DENTAL PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMILES 4 A LIFETIME DENTAL 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:
Provider Other Organization Name Type Code:
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:
1548771645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
141 FRANKLIN PL STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODMERE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11598-1244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-374-2883
Provider Business Mailing Address Fax Number:
516-374-2644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 E 40TH ST RM 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-863-3429
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BERMAN
Authorized Official First Name:
BETH
Authorized Official Middle Name:
LAUREN
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
646-863-3429

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  043829 , 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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