MEDICARE: YAGHI SMILE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1053178186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YAGHI SMILE

Provider Business Mailing Address
First Line	:	1137 OLYMPIA BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-5923
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 SOUTH AVE STE 301
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3426
Country	:	US
Telephone Number	:	347-489-0909
Fax Number	:

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	MOHAMAD YAGHI
Credential	:	DDS
Telephone Number	:	347-570-5857

Provider Enumeration Date	:	03/05/2024
Last Update Date	:	03/05/2024

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Directions to “YAGHI SMILE ” Practice Location

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