Provider Demographics
NPI:1992184717
Name:LITTLE SMILES ON BROADWAY
Entity Type:Organization
Organization Name:LITTLE SMILES ON BROADWAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:P
Authorized Official - Last Name:ABAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-561-3333
Mailing Address - Street 1:133 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3234
Mailing Address - Country:US
Mailing Address - Phone:516-561-3333
Mailing Address - Fax:516-825-1299
Practice Address - Street 1:133 BROADWAY
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3234
Practice Address - Country:US
Practice Address - Phone:516-561-3333
Practice Address - Fax:516-825-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty