Provider Demographics
NPI:1659049633
Name:UNION SQUARE SMILES
Entity Type:Organization
Organization Name:UNION SQUARE SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIN-ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-255-6633
Mailing Address - Street 1:39 E 13TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4663
Mailing Address - Country:US
Mailing Address - Phone:212-255-6633
Mailing Address - Fax:
Practice Address - Street 1:39 E 13TH ST APT 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4663
Practice Address - Country:US
Practice Address - Phone:212-255-6633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1538208137OtherNPPES