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NPI Code Detail

MEDICARE: SMILE LI DENTISTRY LLC

MEDICARE: SMILE LI DENTISTRY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist22DI02496000NJ
2332BC3200XCustomized Equipment (DME)22DI02496000NJ

General Provider Information

NPI Number : 1457899379
Entity Type Code : Organization
Provider Name (Legal Business Name) : SMILE LI DENTISTRY LLC
Provider Business Mailing Address
First Line : 8 SGT HARTZ DR
Second Line :
City : TAPPAN
State : NY
Zip : 10983-1813
Country : US
Telephone Number : 646-287-9300
Fax Number :
Provider Business Practice Location Address
First Line : 525 WANAQUE AVE
Second Line : STE 101
City : POMPTON LAKES
State : NJ
Zip : 07442-1843
Country : US
Telephone Number : 646-287-9300
Fax Number :
Authorized Official
Title or Position : OWNER
Name : YAN LI
Credential :
Telephone Number : 646-287-9300
Provider Enumeration Date : 02/11/2017
Last Update Date : 02/14/2017

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Directions to “SMILE LI DENTISTRY LLC ” Practice Location

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