Healthcare Provider Details

I. General information

NPI: 1831790120
Provider Name (Legal Business Name): ALL SMILES ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 ORINOCO DR
BRIGHTWATERS NY
11718-1827
US

IV. Provider business mailing address

232 ORINOCO DR
BRIGHTWATERS NY
11718-1827
US

V. Phone/Fax

Practice location:
  • Phone: 631-666-7008
  • Fax:
Mailing address:
  • Phone: 631-666-7008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE BRANIGAN
Title or Position: EXECUTIVE ASST
Credential:
Phone: 631-666-7008