Healthcare Provider Details

I. General information

NPI: 1962892901
Provider Name (Legal Business Name): KIDDSMILES II PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NORTHERN BLVD STE 102
MANHASSET NY
11030-3037
US

IV. Provider business mailing address

1201 NORTHERN BLVD STE 102
MANHASSET NY
11030-3037
US

V. Phone/Fax

Practice location:
  • Phone: 516-365-5439
  • Fax: 516-365-5469
Mailing address:
  • Phone: 516-365-5439
  • Fax: 516-365-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. DANA HUTTER
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 631-576-4254