Provider Demographics
NPI:1043340029
Name:BEAUTIFUL SMILES BY YOUR DENT PC
Entity Type:Organization
Organization Name:BEAUTIFUL SMILES BY YOUR DENT PC
Other - Org Name:ZINA GOTLLIEB DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-699-8854
Mailing Address - Street 1:61 55 98TH STREET SUITE 11
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:718-699-8854
Mailing Address - Fax:
Practice Address - Street 1:61 55 98TH STREET SUITE 11
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-699-8854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047344122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty