Provider Demographics
NPI:1184280620
Name:GOTHAM SMILES
Entity type:Organization
Organization Name:GOTHAM SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLAIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-772-8387
Mailing Address - Street 1:13 W 13TH ST APT 7FS
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7936
Mailing Address - Country:US
Mailing Address - Phone:617-970-4835
Mailing Address - Fax:
Practice Address - Street 1:157 EAST 32ND STREET
Practice Address - Street 2:SUITE B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:347-772-8387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental