Provider Demographics
NPI:1669704813
Name:SURE SMILE, LLC
Entity type:Organization
Organization Name:SURE SMILE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:KHEIR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:914-472-9400
Mailing Address - Street 1:1075 CENTRAL PARK AVENUE, SUITE #104
Mailing Address - Street 2:APPLE BANK PLAZA
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583
Mailing Address - Country:US
Mailing Address - Phone:914-472-9400
Mailing Address - Fax:914-723-1160
Practice Address - Street 1:1075 CENTRAL PARK AVENUE, SUITE #104
Practice Address - Street 2:APPLE BANK PLAZA
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583
Practice Address - Country:US
Practice Address - Phone:914-472-9400
Practice Address - Fax:914-723-1160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036832122300000X
NY053281-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1396890752OtherNPI