Provider Demographics
NPI:1366775702
Name:LI DENTISTRY AND SMILE DESIGN, P.C.
Entity type:Organization
Organization Name:LI DENTISTRY AND SMILE DESIGN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PORFIRIO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-683-4455
Mailing Address - Street 1:1927 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2909
Mailing Address - Country:US
Mailing Address - Phone:631-683-4455
Mailing Address - Fax:631-683-4453
Practice Address - Street 1:1927 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-2909
Practice Address - Country:US
Practice Address - Phone:631-683-4455
Practice Address - Fax:631-683-4453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051424261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental