Healthcare Provider Details

I. General information

NPI: 1619793593
Provider Name (Legal Business Name): HEALTHY SMILE DENTAL ARTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 BROADWAY
NEW YORK NY
10031-3206
US

IV. Provider business mailing address

3601 BROADWAY
NEW YORK NY
10031-3206
US

V. Phone/Fax

Practice location:
  • Phone: 212-491-6940
  • Fax:
Mailing address:
  • Phone: 212-491-6940
  • Fax: 212-491-1867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: GRECY ROXANNA MARTINEZ
Title or Position: DENTIST, CEO
Credential: DDS, MAGD
Phone: 212-491-6940