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General NPI Number Information
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NPI Number | 1558736116
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Entity Type | Organization
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Legal Business Name | HEALTHY SMILE NEW YORK DENTISTRY LLC
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Dates
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Enumeration Date | 12/08/2015
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Last Update Date | 12/08/2015
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Provider Practice Location Address
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Address Line | 57 W 57TH ST 1208
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City | NEW YORK
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State | NY
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Zip | 10019-2802
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Country | US
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Telephone | 212-904-0277
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Fax |
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Provider Business Mailing Address
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Address Line | 57 W 57TH ST 1208
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City | NEW YORK
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State | NY
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Zip | 10019-2802
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Country | US
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Telephone | 212-904-0277
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA NICHOLS AMED
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Credential |
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Telephone | 212-904-0277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 053609
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License Number State | NY
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