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General NPI Number Information
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NPI Number | 1922586841
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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 | 08/02/2018
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 750 ROANOKE AVE
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City | RIVERHEAD
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State | NY
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Zip | 11901-2791
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Country | US
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Telephone | 631-727-8585
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Fax | 631-727-8589
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Provider Business Mailing Address
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Address Line | 750 ROANOKE AVE
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City | RIVERHEAD
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State | NY
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Zip | 11901
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Country | US
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Telephone | 631-727-8585
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Fax | 631-727-8589
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Authorized Official
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Title or Position | OWNER
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Name | MR. PARASKEVAS KOURTSOUNIS
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Credential | DDS
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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 | 053121
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License Number State | NY
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