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General NPI Number Information
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NPI Number | 1477438869
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Entity Type | Organization
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Legal Business Name | SMITH HAVEN DENTAL PLLC
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 112 ALEXANDER AVE UNIT A
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City | LAKE GROVE
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State | NY
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Zip | 11755-0429
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Country | US
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Telephone | 631-212-8400
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Fax | 631-212-8433
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Provider Business Mailing Address
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Address Line | 112 ALEXANDER AVE UNIT A
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City | LAKE GROVE
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State | NY
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Zip | 11755-0429
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Country | US
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Telephone | 631-212-8400
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Fax | 631-212-8433
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Authorized Official
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Title or Position | PARTNER
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Name | ALLA FISHMAN
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Credential | DDS
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Telephone | 917-667-5595
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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 |
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License Number State |
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