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General NPI Number Information
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NPI Number | 1003245697
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Entity Type | Organization
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Legal Business Name | BAY RIDGE SMILES
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 9012 5TH AVE BROOKLYN SMILES
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City | BROOKLYN
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State | NY
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Zip | 11209-5908
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Country | US
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Telephone | 718-333-5898
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Fax |
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Provider Business Mailing Address
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Address Line | 9012 5TH AVENUE BROOKLYN SMILES
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City | BROOKLYN
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State | NY
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Zip | 11209
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Country | US
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Telephone | 718-333-5898
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMED A-JANABI
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Credential | DDS
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Telephone | 718-333-5898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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