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General NPI Number Information
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NPI Number | 1144544016
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Entity Type | Organization
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Legal Business Name | KID SMILES PEDIATRIC DENTISTRY PC
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Dates
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Enumeration Date | 03/22/2010
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Last Update Date | 03/22/2010
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Provider Practice Location Address
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Address Line | 22 MAIN ST
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City | YONKERS
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State | NY
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Zip | 10701-2712
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Country | US
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Telephone | 310-210-3952
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Fax |
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Provider Business Mailing Address
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Address Line | 22 MAIN ST
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City | YONKERS
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State | NY
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Zip | 10701-2712
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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 | PEDIATRIC DENTIST/OWNER
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Name | DR. PEGGY FARD
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Credential | DDS
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Telephone | 310-210-3952
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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 | 052977
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License Number State | NY
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