Provider Demographics
NPI:1194599688
Name:SMILE MASTERS LLC
Entity type:Organization
Organization Name:SMILE MASTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & COO
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:MIZRAHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-413-2935
Mailing Address - Street 1:11412 BEACH CHANNEL DR STE 4
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2215
Mailing Address - Country:US
Mailing Address - Phone:718-924-2091
Mailing Address - Fax:
Practice Address - Street 1:11412 BEACH CHANNEL DR STE 4
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2215
Practice Address - Country:US
Practice Address - Phone:718-924-2091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty