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General NPI Number Information
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NPI Number | 1780403444
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Entity Type | Organization
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Legal Business Name | SMILE HOUSE DENTAL P.C.
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 3538 JUNCTION BLVD
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City | CORONA
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State | NY
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Zip | 11368-1775
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Country | US
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Telephone | 347-831-7474
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Fax |
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Provider Business Mailing Address
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Address Line | 3538 JUNCTION BLVD
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City | CORONA
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State | NY
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Zip | 11368-1775
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Country | US
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Telephone | 347-831-7474
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL KHODORKOVSKY
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Credential | DMD
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Telephone | 347-566-0219
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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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