Provider Demographics
NPI:1598818767
Name:SMILE AMERICA DENTAL, PC
Entity type:Organization
Organization Name:SMILE AMERICA DENTAL, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YURIY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZIYEV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-383-1160
Mailing Address - Street 1:851 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-6323
Mailing Address - Country:US
Mailing Address - Phone:718-383-1160
Mailing Address - Fax:718-349-7352
Practice Address - Street 1:851 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-6323
Practice Address - Country:US
Practice Address - Phone:718-383-1160
Practice Address - Fax:718-349-7352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty