Provider Demographics
NPI:1609852649
Name:ZOOM SMILE PC
Entity Type:Organization
Organization Name:ZOOM SMILE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-499-2006
Mailing Address - Street 1:532 ROUTE 304
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2925
Mailing Address - Country:US
Mailing Address - Phone:845-499-2006
Mailing Address - Fax:845-499-2112
Practice Address - Street 1:532 ROUTE 304
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2925
Practice Address - Country:US
Practice Address - Phone:845-499-2006
Practice Address - Fax:845-499-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty