Provider Demographics
NPI:1427448877
Name:KIDDSMILES PEDIATRIC DENTISTRY 4 PLLC
Entity type:Organization
Organization Name:KIDDSMILES PEDIATRIC DENTISTRY 4 PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-576-4254
Mailing Address - Street 1:2211 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4752
Mailing Address - Country:US
Mailing Address - Phone:516-365-5439
Mailing Address - Fax:516-442-1020
Practice Address - Street 1:2211 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4752
Practice Address - Country:US
Practice Address - Phone:516-365-5439
Practice Address - Fax:516-442-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty