Provider Demographics
NPI:1881729630
Name:SMILES BY DESIGN DENTAL PC
Entity type:Organization
Organization Name:SMILES BY DESIGN DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-474-1711
Mailing Address - Street 1:1304 BUCKLEY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4311
Mailing Address - Country:US
Mailing Address - Phone:315-474-1711
Mailing Address - Fax:315-474-4818
Practice Address - Street 1:1304 BUCKLEY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-4311
Practice Address - Country:US
Practice Address - Phone:315-474-1711
Practice Address - Fax:315-474-4818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045257122300000X
NY40578122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6696960001Medicare NSC