Provider Demographics
NPI:1710583158
Name:SIMPLE DENTAL, PLLC
Entity Type:Organization
Organization Name:SIMPLE DENTAL, PLLC
Other - Org Name:DNTL BAR FIDI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WALEED
Authorized Official - Middle Name:BEN
Authorized Official - Last Name:ELCHAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-803-7591
Mailing Address - Street 1:60 W 23RD ST APT 919
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5296
Mailing Address - Country:US
Mailing Address - Phone:201-803-7591
Mailing Address - Fax:
Practice Address - Street 1:26 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-1904
Practice Address - Country:US
Practice Address - Phone:646-969-5632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental