Provider Demographics
NPI:1558023507
Name:SMILE DENTAL WELLNESS PC
Entity Type:Organization
Organization Name:SMILE DENTAL WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SYED RAZA
Authorized Official - Middle Name:HASNAIN
Authorized Official - Last Name:JAFRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-627-8400
Mailing Address - Street 1:444 COMMUNITY DR STE 204
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3820
Mailing Address - Country:US
Mailing Address - Phone:516-627-8400
Mailing Address - Fax:516-627-9047
Practice Address - Street 1:444 COMMUNITY DR STE 204
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3820
Practice Address - Country:US
Practice Address - Phone:516-627-8400
Practice Address - Fax:516-627-9047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental