Provider Demographics
NPI:1538326376
Name:MADISON AVE SMILES DENTAL PC
Entity Type:Organization
Organization Name:MADISON AVE SMILES DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FUAD
Authorized Official - Middle Name:H
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-421-1500
Mailing Address - Street 1:41 E 57TH ST
Mailing Address - Street 2:SUITE 703
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1907
Mailing Address - Country:US
Mailing Address - Phone:212-421-1500
Mailing Address - Fax:212-421-1501
Practice Address - Street 1:41 E 57TH ST
Practice Address - Street 2:SUITE 703
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1907
Practice Address - Country:US
Practice Address - Phone:212-421-1500
Practice Address - Fax:212-421-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental