Provider Demographics
NPI:1699246777
Name:SMILE DESIGN DENTAL STUDIO PLLC
Entity type:Organization
Organization Name:SMILE DESIGN DENTAL STUDIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLYN
Authorized Official - Middle Name:OSAIGBOVO
Authorized Official - Last Name:AGUEBOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-368-0668
Mailing Address - Street 1:320 E 53RD ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5298
Mailing Address - Country:US
Mailing Address - Phone:212-223-7946
Mailing Address - Fax:212-223-7948
Practice Address - Street 1:320 E 53RD ST STE 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5298
Practice Address - Country:US
Practice Address - Phone:212-223-7946
Practice Address - Fax:212-223-7948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental