MEDICARE: NYC DENTAL SMILE TEAM, PLLC

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
1	1223D0001X	Public Health Dentistry

General Provider Information

NPI Number	:	1922861079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYC DENTAL SMILE TEAM, PLLC

Provider Business Mailing Address
First Line	:	130 E 35TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-3815
Country	:	US
Telephone Number	:	212-685-5133
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 E 35TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-3815
Country	:	US
Telephone Number	:	212-685-5133
Fax Number	:

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	ENIS GURI
Credential	:
Telephone Number	:	917-318-4554

Provider Enumeration Date	:	02/01/2024
Last Update Date	:	02/01/2024

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