Provider Demographics
NPI:1629600531
Name:SMART TOOTH DENTAL
Entity Type:Organization
Organization Name:SMART TOOTH DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MIN
Authorized Official - Middle Name:SON
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-424-8818
Mailing Address - Street 1:7617 46TH AVE STE CF1
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3083
Mailing Address - Country:US
Mailing Address - Phone:718-424-8818
Mailing Address - Fax:
Practice Address - Street 1:7617 46TH AVE STE CF1
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3083
Practice Address - Country:US
Practice Address - Phone:718-424-8818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-08
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty