Healthcare Provider Details

I. General information

NPI: 1568366094
Provider Name (Legal Business Name): FRIENDLY SMILE DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2198 BARNES AVE
BRONX NY
10462-1902
US

IV. Provider business mailing address

2198 BARNES AVE
BRONX NY
10462-1902
US

V. Phone/Fax

Practice location:
  • Phone: 718-863-4141
  • Fax: 877-202-2090
Mailing address:
  • Phone: 718-863-4141
  • Fax: 877-202-2090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. ILIA ABRAMOV
Title or Position: DENTIST
Credential: DDS
Phone: 718-863-4141