Provider Demographics
NPI:1093505919
Name:DR. SMILE MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:DR. SMILE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-292-8715
Mailing Address - Street 1:20 HILLYNDALE RD
Mailing Address - Street 2:
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06268-1802
Mailing Address - Country:US
Mailing Address - Phone:917-292-8715
Mailing Address - Fax:
Practice Address - Street 1:36 E 36TH ST STE 204
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3441
Practice Address - Country:US
Practice Address - Phone:917-292-8715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization