Provider Demographics
NPI:1831703115
Name:NYC SMILING DENTIST, PLLC
Entity type:Organization
Organization Name:NYC SMILING DENTIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEHEZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-937-2773
Mailing Address - Street 1:4104 27TH ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4949
Mailing Address - Country:US
Mailing Address - Phone:718-937-2773
Mailing Address - Fax:
Practice Address - Street 1:4104 27TH ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-4949
Practice Address - Country:US
Practice Address - Phone:718-937-2773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NYC SMILING DENTIST, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty