Provider Demographics
NPI:1558004010
Name:GLENDALE DENTAL SMILES PLLC
Entity Type:Organization
Organization Name:GLENDALE DENTAL SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OF LLC
Authorized Official - Prefix:
Authorized Official - First Name:NIRMOLRATTAN
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:CHANDHOKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-306-2704
Mailing Address - Street 1:6507 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-6248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6507 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-6248
Practice Address - Country:US
Practice Address - Phone:718-821-1247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty