Provider Demographics
NPI:1306392584
Name:MAGDY TADROS DDS PC
Entity Type:Organization
Organization Name:MAGDY TADROS DDS PC
Other - Org Name:BRIGTH SMILE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TADROS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-424-4818
Mailing Address - Street 1:6240 WOODHAVEN BLVD
Mailing Address - Street 2:APT #10
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3733
Mailing Address - Country:US
Mailing Address - Phone:718-424-4818
Mailing Address - Fax:718-424-4613
Practice Address - Street 1:6240 WOODHAVEN BLVD
Practice Address - Street 2:APT #10
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3733
Practice Address - Country:US
Practice Address - Phone:718-424-4818
Practice Address - Fax:718-424-4613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056415122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03706645Medicaid