Provider Demographics
NPI:1609268069
Name:GREATER SMILES DENTAL CARE PC
Entity Type:Organization
Organization Name:GREATER SMILES DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:347-962-7246
Mailing Address - Street 1:1900 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1724
Mailing Address - Country:US
Mailing Address - Phone:516-794-9211
Mailing Address - Fax:516-794-9210
Practice Address - Street 1:1900 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 202
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1724
Practice Address - Country:US
Practice Address - Phone:516-794-9211
Practice Address - Fax:516-794-9210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0568811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty