Provider Demographics
NPI:1962549576
Name:SMILE FOR YOU DENTAL PC
Entity type:Organization
Organization Name:SMILE FOR YOU DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHIDKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-727-3333
Mailing Address - Street 1:690 BAY STREET
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-3830
Mailing Address - Country:US
Mailing Address - Phone:718-727-3333
Mailing Address - Fax:718-727-8321
Practice Address - Street 1:690 BAY STREET
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3830
Practice Address - Country:US
Practice Address - Phone:718-727-3333
Practice Address - Fax:718-727-8321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02617081Medicaid