Provider Demographics
NPI:1548852650
Name:SIMPLY SMILES DENTAL PY TY PLLC
Entity type:Organization
Organization Name:SIMPLY SMILES DENTAL PY TY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:YELIZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-756-0111
Mailing Address - Street 1:297 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3589
Mailing Address - Country:US
Mailing Address - Phone:516-756-0111
Mailing Address - Fax:
Practice Address - Street 1:297 MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3589
Practice Address - Country:US
Practice Address - Phone:516-756-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty