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General NPI Number Information
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NPI Number | 1053665414
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Entity Type | Organization
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Legal Business Name | SMILEALIGN ORTHODONTICS
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Dates
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Enumeration Date | 11/06/2012
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 1680 E 19TH ST
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City | BROOKLYN
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State | NY
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Zip | 11229-1312
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Country | US
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Telephone | 718-336-7190
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Fax | 718-645-2024
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Provider Business Mailing Address
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Address Line | 1680 E 19TH ST
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City | BROOKLYN
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State | NY
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Zip | 11229-1312
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Country | US
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Telephone | 718-336-7190
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Fax | 718-645-2024
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Authorized Official
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Title or Position | DENTIST
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Name | DR. THEODORE SAMI WOHL
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Credential | DMD
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Telephone | 718-336-7190
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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 | 046387-1
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License Number State | NY
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