Healthcare Provider Details

I. General information

NPI: 1669266458
Provider Name (Legal Business Name): MODERN DENTAL SMILE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 SUNRISE HWY
MERRICK NY
11566-3745
US

IV. Provider business mailing address

235 SUNRISE HWY
MERRICK NY
11566-3745
US

V. Phone/Fax

Practice location:
  • Phone: 516-855-0070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ISAAK RUBINOV
Title or Position: CO-OWNER
Credential: DDS
Phone: 347-288-8729