Provider Demographics
NPI:1235348277
Name:NORTH SHORE ORTHODONTICS
Entity Type:Organization
Organization Name:NORTH SHORE ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:631-265-3435
Mailing Address - Street 1:50 ROUTE 111
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3700
Mailing Address - Country:US
Mailing Address - Phone:631-265-3435
Mailing Address - Fax:631-382-7913
Practice Address - Street 1:50 ROUTE 111
Practice Address - Street 2:SUITE 214
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3700
Practice Address - Country:US
Practice Address - Phone:631-265-3435
Practice Address - Fax:631-382-7913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0515991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty