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General NPI Number Information
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NPI Number | 1558004010
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Entity Type | Organization
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Legal Business Name | GLENDALE DENTAL SMILES PLLC
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Dates
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Enumeration Date | 04/13/2022
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 6507 MYRTLE AVE
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City | GLENDALE
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State | NY
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Zip | 11385-6248
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Country | US
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Telephone | 718-821-1247
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Fax |
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Provider Business Mailing Address
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Address Line | 6507 MYRTLE AVE
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City | GLENDALE
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State | NY
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Zip | 11385-6248
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER OF LLC
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Name | NIRMOLRATTAN KAUR CHANDHOKE
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Credential | DMD
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Telephone | 718-306-2704
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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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