Healthcare Provider Details

I. General information

NPI: 1952229338
Provider Name (Legal Business Name): SMILES ON LEE PEDIATRIC DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 LEE AVE
BROOKLYN NY
11211-8270
US

IV. Provider business mailing address

124 LEE AVE
BROOKLYN NY
11211-8270
US

V. Phone/Fax

Practice location:
  • Phone: 929-853-0910
  • Fax:
Mailing address:
  • Phone: 929-853-0910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SHALOM BLOBSTEIN
Title or Position: MEMBER
Credential:
Phone: 929-853-0910