Healthcare Provider Details

I. General information

NPI: 1841849965
Provider Name (Legal Business Name): WOODROW LITTLE SMILES FAMILY DENTISTRY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 WOODROW ROAD
STATEN ISLAND NY
10312
US

IV. Provider business mailing address

7001 AMBOY ROAD SUITE #113
STATEN ISLAND NY
10307
US

V. Phone/Fax

Practice location:
  • Phone: 718-317-8524
  • Fax: 347-507-2245
Mailing address:
  • Phone: 718-317-8524
  • Fax: 347-507-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM G. CORBETT
Title or Position: GENERAL DENTIST/OWNER
Credential: DMD
Phone: 718-317-8524