Provider Demographics
NPI:1467700435
Name:SMITH, AMY (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 3RD AVE
Mailing Address - Street 2:6A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1974
Mailing Address - Country:US
Mailing Address - Phone:646-345-9111
Mailing Address - Fax:
Practice Address - Street 1:1441 3RD AVE
Practice Address - Street 2:6A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1974
Practice Address - Country:US
Practice Address - Phone:646-345-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-24
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325451223E0200X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice