Provider Demographics
NPI:1588949515
Name:JAMAICA SMILE DESIGN DENTAL P.C.
Entity type:Organization
Organization Name:JAMAICA SMILE DESIGN DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAPPORT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-291-6871
Mailing Address - Street 1:8835 164TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4056
Mailing Address - Country:US
Mailing Address - Phone:718-291-6871
Mailing Address - Fax:718-291-7362
Practice Address - Street 1:8835 164TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4056
Practice Address - Country:US
Practice Address - Phone:718-291-6871
Practice Address - Fax:718-291-7362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental