Provider Demographics
NPI:1457024812
Name:MAGIC SMILES DENTISTRY OF LINDENHURST, P.C.
Entity Type:Organization
Organization Name:MAGIC SMILES DENTISTRY OF LINDENHURST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:NISSENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-982-2301
Mailing Address - Street 1:3 LEGENDS CIR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-5301
Mailing Address - Country:US
Mailing Address - Phone:516-982-2301
Mailing Address - Fax:
Practice Address - Street 1:826 BUFFALO AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-1658
Practice Address - Country:US
Practice Address - Phone:631-226-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental