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General NPI Number Information
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NPI Number | 1508460411
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Entity Type | Organization
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Legal Business Name | SMILE UPPER EAST DENTAL PLLC
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Dates
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Enumeration Date | 11/23/2020
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 325 EAST 79TH ST UNIT 1B
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City | NEW YORK
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State | NY
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Zip | 10075
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Country | US
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Telephone | 212-897-1833
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Fax | 914-339-5570
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Provider Business Mailing Address
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Address Line | 325 EAST 79TH ST UNIT 1B
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City | NEW YORK
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State | NY
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Zip | 10075
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Country | US
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Telephone | 212-897-1833
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Fax | 914-339-5570
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Authorized Official
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Title or Position | PARTNER
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Name | PETER H CHEN
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Credential | DDS
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Telephone | 212-897-1833
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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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