Healthcare Provider Details

I. General information

NPI: 1750488102
Provider Name (Legal Business Name): STANLEY WARREN SMITH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 THE SERPENTINE
NEW ROCHELLE NY
10801-3512
US

IV. Provider business mailing address

5 THE SERPENTINE
NEW ROCHELLE NY
10801-3512
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-9000
  • Fax:
Mailing address:
  • Phone: 718-584-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number038632-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: