Basic Information
| Provider Information | |||||||||
| NPI: | 1649628173 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEAM A SMILE DENTAL PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7708 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112093402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184913100 | ||||||||
| FaxNumber: | 7184912140 | ||||||||
| Practice Location | |||||||||
| Address1: | 7708 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112093402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184913100 | ||||||||
| FaxNumber: | 7184912140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2016 | ||||||||
| LastUpdateDate: | 05/25/2016 | ||||||||
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| AuthorizedOfficialLastName: | EPELBOYM | ||||||||
| AuthorizedOfficialFirstName: | DMITRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7184913100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.