Provider Demographics
NPI:1114337201
Name:KINDER SMILES DENTAL PC
Entity Type:Organization
Organization Name:KINDER SMILES DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:FOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:845-517-5700
Mailing Address - Street 1:1 HILLCREST CTR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-3740
Mailing Address - Country:US
Mailing Address - Phone:845-517-5700
Mailing Address - Fax:
Practice Address - Street 1:1 HILLCREST CTR
Practice Address - Street 2:SUITE 107
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-3740
Practice Address - Country:US
Practice Address - Phone:845-517-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty