Provider Demographics
NPI:1548903826
Name:MIGHTY SMILES DENTAL CARE PLLC
Entity type:Organization
Organization Name:MIGHTY SMILES DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-885-3757
Mailing Address - Street 1:837 59TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3611
Mailing Address - Country:US
Mailing Address - Phone:718-676-1176
Mailing Address - Fax:718-676-0276
Practice Address - Street 1:837 59TH ST FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3611
Practice Address - Country:US
Practice Address - Phone:718-676-1176
Practice Address - Fax:718-676-0276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty