Provider Demographics
NPI:1629433032
Name:DENTAL PRIDE/ SMILE CAFE
Entity Type:Organization
Organization Name:DENTAL PRIDE/ SMILE CAFE
Other - Org Name:DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-779-7743
Mailing Address - Street 1:45 PARK AVE
Mailing Address - Street 2:PROFESSIONAL UNIT 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3487
Mailing Address - Country:US
Mailing Address - Phone:212-779-7743
Mailing Address - Fax:212-779-3490
Practice Address - Street 1:45 PARK AVE
Practice Address - Street 2:PROFESSIONAL UNIT 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-779-7743
Practice Address - Fax:212-779-3490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049632-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty