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General NPI Number Information
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NPI Number | 1043340029
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Entity Type | Organization
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Legal Business Name | BEAUTIFUL SMILES BY YOUR DENT PC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 61 55 98TH STREET SUITE 11
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City | REGO PARK
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State | NY
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Zip | 11374
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Country | US
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Telephone | 718-699-8854
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Fax |
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Provider Business Mailing Address
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Address Line | 61 55 98TH STREET SUITE 11
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City | REGO PARK
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State | NY
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Zip | 11374
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Country | US
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Telephone | 718-699-8854
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. ZINA S GOTLIEB
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Credential | DDS
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Telephone | 718-699-8854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 047344
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License Number State | NY
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