Provider Demographics
NPI:1740590637
Name:SMILE ZONE DENTISTRY CLINTONDALE PC
Entity Type:Organization
Organization Name:SMILE ZONE DENTISTRY CLINTONDALE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:BAJAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-883-6849
Mailing Address - Street 1:2 MAPLE AVE.
Mailing Address - Street 2:
Mailing Address - City:CLINTONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12515
Mailing Address - Country:US
Mailing Address - Phone:845-883-6849
Mailing Address - Fax:845-883-0919
Practice Address - Street 1:2 MAPLE AVE.
Practice Address - Street 2:
Practice Address - City:CLINTONDALE
Practice Address - State:NY
Practice Address - Zip Code:12515
Practice Address - Country:US
Practice Address - Phone:845-883-6849
Practice Address - Fax:845-883-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049729-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty