Provider Demographics
NPI:1114199346
Name:VIP SMILES DENTISTRY PC
Entity Type:Organization
Organization Name:VIP SMILES DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATRISE
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-262-6054
Mailing Address - Street 1:119 W 57TH STREET
Mailing Address - Street 2:SUITE 512
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-262-6054
Mailing Address - Fax:212-765-2831
Practice Address - Street 1:119 W 57TH STREET
Practice Address - Street 2:SUITE 512
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-262-6054
Practice Address - Fax:212-765-2831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY046889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty