Healthcare Provider Details

I. General information

NPI: 1992584718
Provider Name (Legal Business Name): FRESHEST SMILES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 FORT WASHINGTON AVE APT 1B
NEW YORK NY
10033-3533
US

IV. Provider business mailing address

PO BOX 1097
BRONX NY
10453-1015
US

V. Phone/Fax

Practice location:
  • Phone: 718-294-3725
  • Fax:
Mailing address:
  • Phone: 718-294-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEJANDRO WILLIAMS
Title or Position: OWNER
Credential: DDS
Phone: 718-294-3725