Provider Demographics
NPI: | 1366033441 |
---|---|
Name: | MONSEY SMILES DENTAL PLLC |
Entity Type: | Organization |
Organization Name: | MONSEY SMILES DENTAL PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRACTICE MANAGER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | FRAIDY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HOFFMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 845-613-3110 |
Mailing Address - Street 1: | 382 A ROUTE 59 |
Mailing Address - Street 2: | |
Mailing Address - City: | AIRMONT |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10952 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 845-613-3110 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 382 A ROUTE 59 |
Practice Address - Street 2: | |
Practice Address - City: | AIRMONT |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10952 |
Practice Address - Country: | US |
Practice Address - Phone: | 845-613-3110 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-02-01 |
Last Update Date: | 2021-02-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223P0221X | Dental Providers | Dentist | Pediatric Dentistry | Group - Multi-Specialty |
No | 1223X0400X | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics | Group - Multi-Specialty |