Provider Demographics
NPI:1205043429
Name:ENVY SMILE DENTAL PC
Entity Type:Organization
Organization Name:ENVY SMILE DENTAL PC
Other - Org Name:DR MARIANNA WEINER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-891-0606
Mailing Address - Street 1:1738 EAST 13TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:718-891-0606
Mailing Address - Fax:
Practice Address - Street 1:1738 EAST 13TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-891-0606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0459131223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty