MEDICARE: SIMPLY SMILES DENTAL BUSHWICK 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	122300000X	Dentist

General Provider Information

NPI Number	:	1720937972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLY SMILES DENTAL BUSHWICK PC

Provider Business Mailing Address
First Line	:	415 KNICKERBOCKER AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4991
Country	:	US
Telephone Number	:	347-462-3707
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 KNICKERBOCKER AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4991
Country	:	US
Telephone Number	:	347-462-3707
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KAREEM FATOUH
Credential	:
Telephone Number	:	914-924-2286

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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