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General NPI Number Information
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NPI Number | 1689470239
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Entity Type | Organization
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Legal Business Name | SUPERSMILES KDS DENTAL PC
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 2318 31ST ST STE 320
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City | ASTORIA
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State | NY
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Zip | 11105-2765
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Country | US
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Telephone | 718-635-3222
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Fax |
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Provider Business Mailing Address
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Address Line | 500 PORTION RD STE 16
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City | RONKONKOMA
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State | NY
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Zip | 11779-4587
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Country | US
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Telephone | 631-451-7700
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | CHRISTINE BRANIGAN
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Credential |
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Telephone | 631-451-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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