MEDICARE: SMILE BY DESIGN DENTISTRY, P.C.

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	054409	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295264216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE BY DESIGN DENTISTRY, P.C.

Provider Business Mailing Address
First Line	:	1603 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6310
Country	:	US
Telephone Number	:	718-265-6699
Fax Number	:	718-228-7522

Provider Business Practice Location Address
First Line	:	1603 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6310
Country	:	US
Telephone Number	:	718-265-6699
Fax Number	:	718-228-7522

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	NADIIA SHUBINA
Credential	:
Telephone Number	:	718-265-6699

Provider Enumeration Date	:	06/05/2017
Last Update Date	:	07/21/2022

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Directions to “SMILE BY DESIGN DENTISTRY, P.C. ” Practice Location

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