Provider Demographics
NPI:1275008138
Name:GRACE DENTAL SMILES
Entity Type:Organization
Organization Name:GRACE DENTAL SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVINASH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:631-619-0010
Mailing Address - Street 1:102 ROUTE 109
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-6220
Mailing Address - Country:US
Mailing Address - Phone:631-619-0010
Mailing Address - Fax:631-983-4774
Practice Address - Street 1:102 ROUTE 109
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-6220
Practice Address - Country:US
Practice Address - Phone:631-619-0010
Practice Address - Fax:631-983-4774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental