Provider Demographics
NPI:1598151250
Name:GO SMILE ORTHODONTICS
Entity Type:Organization
Organization Name:GO SMILE ORTHODONTICS
Other - Org Name:STRAIGHT SET ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-584-4906
Mailing Address - Street 1:520 FRANKLIN AVE
Mailing Address - Street 2:L-19
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5806
Mailing Address - Country:US
Mailing Address - Phone:516-248-2560
Mailing Address - Fax:516-248-2590
Practice Address - Street 1:520 FRANKLIN AVE
Practice Address - Street 2:L-19
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5806
Practice Address - Country:US
Practice Address - Phone:516-248-2560
Practice Address - Fax:516-248-2590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0510051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty