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General NPI Number Information
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NPI Number | 1144700451
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Entity Type | Organization
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Legal Business Name | EXECUTIVE SMILES INC
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 08/16/2018
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Provider Practice Location Address
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Address Line | 460 ATLANTIC AVE
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City | EAST ROCKAWAY
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State | NY
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Zip | 11518-1547
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Country | US
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Telephone | 516-792-6533
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Fax | 516-792-6533
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Provider Business Mailing Address
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Address Line | 47 STEPPING STONE LN
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City | GREAT NECK
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State | NY
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Zip | 11024-1313
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Country | US
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Telephone | 516-792-6533
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Fax | 516-792-6533
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ARSHIA GOLIAN
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Credential | DDS
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Telephone | 516-792-6533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 057005-1
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License Number State | NY
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