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General NPI Number Information
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NPI Number | 1629865480
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Entity Type | Organization
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Legal Business Name | FRESH SMILES PLLC
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 6709 FRESH POND RD FL 2
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City | RIDGEWOOD
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State | NY
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Zip | 11385-4505
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Country | US
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Telephone | 718-261-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 6709 FRESH POND RD FL 2
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City | RIDGEWOOD
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State | NY
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Zip | 11385-4505
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Country | US
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Telephone | 718-261-4000
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Fax |
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Authorized Official
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Title or Position | COORDINATOR
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Name | ALICIA PITKOUVICH
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Credential |
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Telephone | 917-391-8000
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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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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