Provider Demographics
NPI:1235407727
Name:SMILE FOR LIFE DENTAL, P.C.
Entity Type:Organization
Organization Name:SMILE FOR LIFE DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TUVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-417-6453
Mailing Address - Street 1:918 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-5339
Mailing Address - Country:US
Mailing Address - Phone:718-417-6453
Mailing Address - Fax:718-366-3300
Practice Address - Street 1:918 CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5339
Practice Address - Country:US
Practice Address - Phone:718-417-6453
Practice Address - Fax:718-366-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02829394Medicaid