Provider Demographics
NPI:1760197438
Name:NOSTRAND AVE SMILES DENTAL PC
Entity Type:Organization
Organization Name:NOSTRAND AVE SMILES DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:IANCU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-375-9257
Mailing Address - Street 1:3310 NOSTRAND AVE STE L3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3739
Mailing Address - Country:US
Mailing Address - Phone:718-357-9257
Mailing Address - Fax:
Practice Address - Street 1:3310 NOSTRAND AVE STE L3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3739
Practice Address - Country:US
Practice Address - Phone:718-357-9257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty