Provider Demographics
NPI:1619793593
Name:HEALTHY SMILE DENTAL ARTS P C
Entity type:Organization
Organization Name:HEALTHY SMILE DENTAL ARTS P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:GRECY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-491-6940
Mailing Address - Street 1:3601 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-3206
Mailing Address - Country:US
Mailing Address - Phone:212-491-6940
Mailing Address - Fax:
Practice Address - Street 1:3601 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-3206
Practice Address - Country:US
Practice Address - Phone:212-491-6940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
No122300000XDental ProvidersDentistGroup - Multi-Specialty