Provider Demographics
NPI:1609023738
Name:BEAUTIFUL SMILES OF LONG ISLAND DENTISTRY PLLC
Entity Type:Organization
Organization Name:BEAUTIFUL SMILES OF LONG ISLAND DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:LYLE
Authorized Official - Last Name:ZATCOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:516-352-8282
Mailing Address - Street 1:700 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:516-352-8282
Mailing Address - Fax:
Practice Address - Street 1:700 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:516-352-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051010261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental