Provider Demographics
NPI:1902157910
Name:PERFECT SMILE BRACES, P.C.
Entity Type:Organization
Organization Name:PERFECT SMILE BRACES, P.C.
Other - Org Name:PERFECT SMILE BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:347-801-8888
Mailing Address - Street 1:555 E FORDHAM RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5046
Mailing Address - Country:US
Mailing Address - Phone:347-801-8888
Mailing Address - Fax:347-801-8888
Practice Address - Street 1:555 E FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5046
Practice Address - Country:US
Practice Address - Phone:347-801-8888
Practice Address - Fax:347-801-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223P0221X, 1223X0400X
NY0575641223X0400X
NY0591521223X0400X
NY0570471223X0400X
NY0557551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1295272441OtherNISHI GARG, DMD TYPE 1 NPI ASSOCIATE
1790041523OtherEMIL BAILEY, DMD TYPE 1 NPI
1578957270OtherZACHARY HIRSCH, DDS TYPE 1 NPI
NY05333019Medicaid
NY1235567173OtherJEONG RAE CHO, DDS TYPE 1 NPI