| Organization Name: | SMILE NEW YORK OUTREACH LLC |
| NPI Number: | 1063794618 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ELLIOT PAUL SCHLANG (DENTAL DIRECTOR) |
| Mailing Address: | 3100 47th Ave Long Island City |
| State: | NY US |
| Postal Code: | 111013013 |
| Phone Number: | 7183616160 |
| Fax Number: | 7183611660 |
| NPI Enumeration Date: | 09/09/2011 |
| NPI Last Update Date: | 09/19/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 7003272R |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |