Dynamic Smile Dental PLLC

Primary specialty

DentistTaxonomy code 122300000X

License

051245 Issued in NY

Legal business name

DYNAMIC SMILE DENTAL PLLC

Practice address

80 Bowery
Room #400
New York, NY 10013-4614

Phone

(212) 219-8230

NPI assigned

Nov 24, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Diana Lee, DDS

Title

Sole Proprietor

Phone

(212) 219-8230

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1448323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448323200000",
    "number": "1073987301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 BOWERY",
            "address_2": "ROOM #400",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100134614",
            "telephone_number": "212-219-8230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 BOWERY",
            "address_2": "ROOM #400",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100134614",
            "telephone_number": "212-219-8230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC SMILE DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-24",
        "last_updated": "2015-11-24",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "212-219-8230",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "051245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in New York, NY
• Providers in New York, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.