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General NPI Number Information
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NPI Number | 1548771645
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Entity Type | Organization
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Legal Business Name | SMILES 4 A LIFETIME DENTAL PLLC
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Dates
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Enumeration Date | 10/16/2017
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Last Update Date | 10/16/2017
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Provider Practice Location Address
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Address Line | 110 E 40TH ST RM 200
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City | NEW YORK
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State | NY
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Zip | 10016-1801
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Country | US
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Telephone | 646-863-3429
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Fax |
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Provider Business Mailing Address
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Address Line | 141 FRANKLIN PL STE A
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City | WOODMERE
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State | NY
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Zip | 11598-1244
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Country | US
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Telephone | 516-374-2883
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Fax | 516-374-2644
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BETH LAUREN BERMAN
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Credential |
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Telephone | 646-863-3429
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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 | 043829
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License Number State | NY
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