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General NPI Number Information
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NPI Number | 1891639746
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Entity Type | Organization
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Legal Business Name | HOLLYWOOD SMILE DENTAL
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Dates
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Enumeration Date | 04/20/2026
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Last Update Date | 04/20/2026
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Provider Practice Location Address
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Address Line | 9750 QUEENS BLVD STE G2
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City | REGO PARK
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State | NY
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Zip | 11374-3211
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Country | US
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Telephone | 718-830-0110
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Fax | 718-532-0456
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Provider Business Mailing Address
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Address Line | 611 BRIDGE ST
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City | WOODMERE
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State | NY
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Zip | 11598-1509
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Country | US
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Telephone | 917-604-6925
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Fax | 718-532-0456
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Authorized Official
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Title or Position | OWNER
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Name | DR. YEFIM KHANIMOV
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Credential | DDS
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Telephone | 917-604-6925
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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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