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General NPI Number Information
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NPI Number | 1619793593
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Entity Type | Organization
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Legal Business Name | HEALTHY SMILE DENTAL ARTS P C
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 3601 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10031-3206
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Country | US
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Telephone | 212-491-6940
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10031-3206
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Country | US
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Telephone | 212-491-6940
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Fax |
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Authorized Official
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Title or Position | DOCTOR/AUTHORIZED OFFICIAL
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Name | GRECY MARTINEZ
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Credential | DDS
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Telephone | 212-491-6940
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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