Provider Demographics
NPI:1063871374
Name:SMILES PERFECTED ORTHODONTICS
Entity type:Organization
Organization Name:SMILES PERFECTED ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEIRIF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-459-7900
Mailing Address - Street 1:10460 QUEENS BLVD
Mailing Address - Street 2:1F
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7318
Mailing Address - Country:US
Mailing Address - Phone:718-459-7900
Mailing Address - Fax:718-459-5965
Practice Address - Street 1:10460 QUEENS BLVD
Practice Address - Street 2:1F
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7318
Practice Address - Country:US
Practice Address - Phone:718-459-7900
Practice Address - Fax:718-459-5965
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIMON CHEIRIF DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty