Healthcare Provider Details

I. General information

NPI: 1144626441
Provider Name (Legal Business Name): SMILE ZONE DENTISTRY, HIGHLAND MILLS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 STATE ROUTE 32
HIGHLAND MILLS NY
10930-5200
US

IV. Provider business mailing address

583 STATE ROUTE 32
HIGHLAND MILLS NY
10930-5200
US

V. Phone/Fax

Practice location:
  • Phone: 845-928-3348
  • Fax:
Mailing address:
  • Phone: 845-928-3348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: RACHNA BAJAJ
Title or Position: PRESIDENT
Credential:
Phone: 845-928-3348