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General NPI Number Information
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NPI Number | 1760809586
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Entity Type | Organization
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Legal Business Name | L I DENTISTRY AND SMILE DESIGN II, P.C.
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 612 W 178TH ST SUITE 1
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City | NEW YORK
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State | NY
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Zip | 10033-6550
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Country | US
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Telephone | 212-795-3246
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Fax | 212-795-3249
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Provider Business Mailing Address
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Address Line | 612 W 178TH ST 1
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City | NEW YORK
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State | NY
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Zip | 10033-6550
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Country | US
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Telephone | 212-795-3246
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Fax | 212-795-3249
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PORFIRIO A NUNEZ
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Credential | DDS
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Telephone | 212-795-3246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 051424
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License Number State | NY
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