Provider Demographics
NPI:1699225078
Name:NEW YORK SMILE SPECIALISTS
Entity Type:Organization
Organization Name:NEW YORK SMILE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE, PROSTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:RAWDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-247-4194
Mailing Address - Street 1:200 CENTRAL PARK S APT 206
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1450
Mailing Address - Country:US
Mailing Address - Phone:212-247-4194
Mailing Address - Fax:
Practice Address - Street 1:200 CENTRAL PARK S APT 206
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1450
Practice Address - Country:US
Practice Address - Phone:212-247-4194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058826261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental