Provider Demographics
NPI:1235529678
Name:KIDDSMILES DDS 3 PLLC
Entity Type:Organization
Organization Name:KIDDSMILES DDS 3 PLLC
Other - Org Name:KIDDSMILES DDS 3 PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-576-4254
Mailing Address - Street 1:315 MAIN ST STE 315-I
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-1524
Mailing Address - Country:US
Mailing Address - Phone:631-254-5437
Mailing Address - Fax:631-676-4071
Practice Address - Street 1:315 MAIN ST STE 315-I
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1524
Practice Address - Country:US
Practice Address - Phone:631-254-5437
Practice Address - Fax:631-676-4071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty