Kid Smiles Pediatric Dentistry of Port Jefferson Station PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

KID SMILES PEDIATRIC DENTISTRY OF PORT JEFFERSON STATION PLLC

Practice address

1174 Route 112 Ste B
Port Jefferson Station, NY 11776-8033

Phone

(631) 676-4071

Fax

(516) 588-9221

NPI assigned

Mar 13, 2023

Organization subpart

No

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

Authorized official

Name

Cynthia Lynn Pastore

Title

Insurance Coordinator

Phone

(516) 548-8753

Specialties & licenses 1

Addresses

Other names 1

• Kid Smiles Pediatric Dentistry of Port Jefferson Station PLLC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michele Kaider-Alstodt

  • Pediatric Dentistry
  • North Babylon, NY
  • NPI 1396946026
  NPD

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

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678665600000",
    "number": "1144921602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1174 ROUTE 112 STE B",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117768033",
            "telephone_number": "631-676-4071",
            "fax_number": "516-588-9221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1174 ROUTE 112 STE B",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117768033",
            "telephone_number": "631-676-4071",
            "fax_number": "516-588-9221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KID SMILES PEDIATRIC DENTISTRY OF PORT JEFFERSON STATION PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-13",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A",
        "authorized_official_last_name": "PASTORE",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "516-548-8753"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kid Smiles Pediatric Dentistry of Port Jefferson Station PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Howard Kessler, O.D.
• Laura Pavel Ketelsen, CRNA
• Karin Marie Keyes, LCSW
• Hiba Khan, MA-MFT
• Zarlasht Khan
• Kids First Pediatrics, PC
• Kim Lehnert, Psychology, PH.D., PLLC
• Jamey Kim
• Sang H Kim
• Victoria Kim

• Pediatric Dentistry in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Pediatric Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; 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.