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General NPI Number Information
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NPI Number | 1386300390
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Entity Type | Organization
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Legal Business Name | LITTLE GRINS PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 11/14/2021
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Last Update Date | 11/14/2021
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Provider Practice Location Address
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Address Line | 160 E 88TH ST APT 1D
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City | NEW YORK
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State | NY
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Zip | 10128-2217
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Country | US
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Telephone | 917-979-6579
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Fax |
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Provider Business Mailing Address
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Address Line | 160 E 88TH ST APT 1D
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City | NEW YORK
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State | NY
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Zip | 10128-2217
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Country | US
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Telephone | 917-979-6579
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LIEL GRINBAUM
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Credential | DMD
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Telephone | 516-680-6915
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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 |
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License Number State |
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