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General NPI Number Information
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NPI Number | 1114291176
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Entity Type | Organization
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Legal Business Name | DENTAL SMILES FOR KIDS, LLC
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Dates
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Enumeration Date | 03/07/2012
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 1815 FRANCIS LEWIS BLVD
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City | WHITESTONE
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State | NY
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Zip | 11357-3836
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Country | US
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Telephone | 718-746-1230
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Fax |
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Provider Business Mailing Address
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Address Line | 1815 FRANCIS LEWIS BLVD
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City | WHITESTONE
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State | NY
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Zip | 11357-3836
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Country | US
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Telephone | 718-746-1230
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | PARASKEVIS KOURTSOUNIS
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Credential | D.D.S.
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Telephone | 718-746-1230
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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 | 50051520
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License Number State | NY
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