Provider Demographics
NPI:1386300390
Name:LITTLE GRINS PEDIATRIC DENTISTRY PLLC
Entity type:Organization
Organization Name:LITTLE GRINS PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:516-680-6915
Mailing Address - Street 1:160 E 88TH ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2217
Mailing Address - Country:US
Mailing Address - Phone:917-979-6579
Mailing Address - Fax:
Practice Address - Street 1:160 E 88TH ST APT 1D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2217
Practice Address - Country:US
Practice Address - Phone:917-979-6579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-14
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY186-175-1224OtherNPI