Healthcare Provider Details

I. General information

NPI: 1134979800
Provider Name (Legal Business Name): MARVEL SMILES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 BOSTON RD
BRONX NY
10469-2451
US

IV. Provider business mailing address

388A UNDERCLIFF AVE
EDGEWATER NJ
07020-7251
US

V. Phone/Fax

Practice location:
  • Phone: 718-547-5280
  • Fax:
Mailing address:
  • Phone: 212-220-3333
  • Fax: 212-220-3333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. ANURAG HARSH
Title or Position: CEO
Credential:
Phone: 212-220-3333