Provider Demographics
NPI:1154067981
Name:SIMPLY DENTISTRY OF THE NORTH SHORE
Entity Type:Organization
Organization Name:SIMPLY DENTISTRY OF THE NORTH SHORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:LERMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-216-1329
Mailing Address - Street 1:935 NORTHERN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5309
Mailing Address - Country:US
Mailing Address - Phone:516-482-0440
Mailing Address - Fax:
Practice Address - Street 1:935 NORTHERN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5309
Practice Address - Country:US
Practice Address - Phone:516-482-0440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental