Provider Demographics
NPI:1376927194
Name:SMILE BROOKLYN DENTAL, PC
Entity Type:Organization
Organization Name:SMILE BROOKLYN DENTAL, PC
Other - Org Name:INTERFAITH DENTAL, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN OF DENTAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-613-7385
Mailing Address - Street 1:1545 ATLANTIC AVE
Mailing Address - Street 2:EAST BUILDING
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-1122
Mailing Address - Country:US
Mailing Address - Phone:718-613-7140
Mailing Address - Fax:718-504-6259
Practice Address - Street 1:1545 ATLANTIC AVE
Practice Address - Street 2:EAST BUILDING
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1122
Practice Address - Country:US
Practice Address - Phone:718-613-7140
Practice Address - Fax:718-504-6259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental