MEDICARE: SYRACUSE DENTAL SMILE DESIGN, PC

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	1223P0700X	Prosthodontics

General Provider Information

NPI Number	:	1265369581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYRACUSE DENTAL SMILE DESIGN, PC

Provider Business Mailing Address
First Line	:	4311 E GENESEE ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13214-2121
Country	:	US
Telephone Number	:	315-885-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4311 E GENESEE ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13214-2121
Country	:	US
Telephone Number	:	315-885-5600
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	KYM MCAREAVY
Credential	:
Telephone Number	:	585-319-5400

Provider Enumeration Date	:	05/08/2026
Last Update Date	:	05/08/2026

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