Provider Demographics
NPI:1750846721
Name:SMILE SCARSDALE PEDIATRIC DENTISTRY AND ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:SMILE SCARSDALE PEDIATRIC DENTISTRY AND ORTHODONTICS PLLC
Other - Org Name:SMILE SCARSDALE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-722-5100
Mailing Address - Street 1:1075 CENTRAL PARK AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3232
Mailing Address - Country:US
Mailing Address - Phone:914-722-5100
Mailing Address - Fax:
Practice Address - Street 1:1075 CENTRAL PARK AVE STE 400
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3232
Practice Address - Country:US
Practice Address - Phone:914-722-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty