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General NPI Number Information
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NPI Number | 1730628595
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Entity Type | Organization
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Legal Business Name | LET'S SMILE DENTAL
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 208 E 116TH ST
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City | NEW YORK
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State | NY
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Zip | 10029-1451
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Country | US
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Telephone | 212-831-8940
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Fax | 212-831-3637
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Provider Business Mailing Address
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Address Line | 208 E 116TH ST
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City | NEW YORK
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State | NY
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Zip | 10029-1451
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Country | US
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Telephone | 212-831-8940
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Fax | 212-831-3637
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. IMRAN MAHMOOD AHMED
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Credential | DMD
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Telephone | 248-495-1549
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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 | 050477
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License Number State | NY
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