Provider Demographics
NPI:1144586579
Name:EVERLASTING SMILES
Entity Type:Organization
Organization Name:EVERLASTING SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FAEQ
Authorized Official - Middle Name:K
Authorized Official - Last Name:AFRIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-833-9111
Mailing Address - Street 1:26701 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1743
Mailing Address - Country:US
Mailing Address - Phone:646-833-9111
Mailing Address - Fax:718-343-7792
Practice Address - Street 1:26701 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004-1743
Practice Address - Country:US
Practice Address - Phone:646-833-9111
Practice Address - Fax:718-343-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2014-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055684122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03386743Medicaid