Provider Demographics
NPI:1013663061
Name:DI SMILES DENTAL PC
Entity type:Organization
Organization Name:DI SMILES DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ILYAICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-476-2772
Mailing Address - Street 1:575 UNDERHILL BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3416
Mailing Address - Country:US
Mailing Address - Phone:516-496-3880
Mailing Address - Fax:
Practice Address - Street 1:575 UNDERHILL BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3416
Practice Address - Country:US
Practice Address - Phone:516-496-3880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental