Provider Demographics
NPI:1396221909
Name:ULTIMATE SMILE DENTAL, PC
Entity Type:Organization
Organization Name:ULTIMATE SMILE DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:HUERTA-ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-820-1250
Mailing Address - Street 1:3349 MONROE AVE STE 334
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5513
Mailing Address - Country:US
Mailing Address - Phone:585-820-1250
Mailing Address - Fax:
Practice Address - Street 1:7181 STATE ROUTE 96
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-8989
Practice Address - Country:US
Practice Address - Phone:585-924-4050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052271261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental