Provider Demographics
NPI:1548017254
Name:SMILIST DENTAL MD PC
Entity type:Organization
Organization Name:SMILIST DENTAL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-790-4886
Mailing Address - Street 1:40 CUTTERMILL RD STE 500
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3213
Mailing Address - Country:US
Mailing Address - Phone:562-965-3304
Mailing Address - Fax:
Practice Address - Street 1:40 CUTTERMILL RD STE 500
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3213
Practice Address - Country:US
Practice Address - Phone:562-965-3304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty