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General NPI Number Information
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NPI Number | 1053178186
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Entity Type | Organization
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Legal Business Name | YAGHI SMILE
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Dates
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Enumeration Date | 03/05/2024
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 900 SOUTH AVE STE 301
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3426
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Country | US
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Telephone | 347-489-0909
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Fax |
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Provider Business Mailing Address
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Address Line | 1137 OLYMPIA BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10306-5923
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | MOHAMAD YAGHI
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Credential | DDS
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Telephone | 347-570-5857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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