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General NPI Number Information
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NPI Number | 1194990119
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Entity Type | Organization
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Legal Business Name | DREAM SMILE LLC
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 57 WEST 57 STREET SUITE 1207
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City | NEW YORK
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State | NY
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Zip | 10019
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Country | US
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Telephone | 212-421-2131
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Fax |
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Provider Business Mailing Address
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Address Line | 57 WEST 57TH STREET SUITE 1207
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City | NEW YORK
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State | NY
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Zip | 10019
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Country | US
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Telephone | 212-421-2131
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Fax |
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Authorized Official
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Title or Position | EMPLOYER
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Name | MR. GREGORY SKINNER
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Credential | D.D.S.
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Telephone | 212-421-2131
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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 | 046610
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License Number State | NY
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