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General NPI Number Information
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NPI Number | 1609852649
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Entity Type | Organization
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Legal Business Name | ZOOM SMILE PC
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 10/01/2013
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Provider Practice Location Address
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Address Line | 532 ROUTE 304
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City | NEW CITY
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State | NY
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Zip | 10956-2925
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Country | US
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Telephone | 845-499-2006
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Fax | 845-499-2112
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Provider Business Mailing Address
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Address Line | 532 ROUTE 304
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City | NEW CITY
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State | NY
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Zip | 10956-2925
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Country | US
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Telephone | 845-499-2006
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Fax | 845-499-2112
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Authorized Official
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Title or Position | PRESIDENT/ DENTIST
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Name | DR. KEITH MA
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Credential | DDS
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Telephone | 845-499-2006
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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 | 043709
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License Number State | NY
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