Provider Demographics
NPI:1215764766
Name:NY SMILE DESTINATION DENTAL CATE PC, INC.
Entity type:Organization
Organization Name:NY SMILE DESTINATION DENTAL CATE PC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:HERAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-384-7215
Mailing Address - Street 1:440 E 79TH ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1407
Mailing Address - Country:US
Mailing Address - Phone:212-697-6453
Mailing Address - Fax:646-882-6888
Practice Address - Street 1:440 E 79TH ST APT 1F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1407
Practice Address - Country:US
Practice Address - Phone:212-697-6453
Practice Address - Fax:646-882-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental