Healthcare Provider Details

I. General information

NPI: 1942911813
Provider Name (Legal Business Name): USMANI DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/12/2022
Certification Date: 12/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 E MIDDLE COUNTRY RD STE 8
SMITHTOWN NY
11787-2818
US

IV. Provider business mailing address

35 BRAYTON CT N
SOUTH SETAUKET NY
11720-4624
US

V. Phone/Fax

Practice location:
  • Phone: 631-361-7030
  • Fax:
Mailing address:
  • Phone: 631-525-7161
  • 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. MOHAMMAD ASAD USMANI
Title or Position: MANAGING MEMBER
Credential: DMD
Phone: 631-525-7161