Provider Demographics
NPI:1417557059
Name:SMILES AND GRINS PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:SMILES AND GRINS PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:516-680-6915
Mailing Address - Street 1:160 E 88TH ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2217
Mailing Address - Country:US
Mailing Address - Phone:212-777-6177
Mailing Address - Fax:
Practice Address - Street 1:160 E 88TH ST APT 1D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2217
Practice Address - Country:US
Practice Address - Phone:212-777-6177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty