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General NPI Number Information
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NPI Number | 1942470406
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Entity Type | Organization
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Legal Business Name | LIS SMILE DENTAL OFFICE PC
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 6924 13TH AVE SUI1FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11228-1624
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Country | US
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Telephone | 718-238-4545
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Fax | 718-238-9084
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Provider Business Mailing Address
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Address Line | 6924 13TH AVE STE 1
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City | BROOKLYN
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State | NY
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Zip | 11228-1624
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Country | US
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Telephone | 718-238-4545
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Fax | 718-238-9084
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. ZEENA LI
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Credential | DDS
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Telephone | 718-238-4545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 047770-1
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License Number State | NY
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