NPIMap

Organization Active NPI

Supersmiles Dental PLLC

Doing business as Supersmiles Pediatric Dentistry IV

  • Pediatric Dentistry
  • Medford, NY
National Provider Identifier
1255124509
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
SUPERSMILES DENTAL PLLC
Doing business as
Supersmiles Pediatric Dentistry IV
Practice address
1719 N Ocean Ave Ste C
Medford, NY 11763-2669
Phone
(631) 289-0007
NPI assigned
May 28, 2025
Last updated
Jul 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2025

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

Authorized official

Name
Christine Branigan
Title
Credentialing
Phone
(631) 451-7700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

1719 N Ocean Ave Ste C
Medford, NY 11763-2669

Mailing address

500 Portion Rd Ste 16
Ronkonkoma, NY 11779-4587
Phone (631) 451-7700

Other names 1

  • Supersmiles Pediatric Dentistry IV Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Supersmiles Dental PLLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1719 N Ocean Ave
Ste C
Medford, NY 11763
Phone (631) 289-0007

NPI Registry JSON

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

{
    "created_epoch": "1748390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751846400000",
    "number": "1255124509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 PORTION RD STE 16",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117794587",
            "telephone_number": "631-451-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1719 N OCEAN AVE STE C",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117632669",
            "telephone_number": "631-289-0007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERSMILES DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-28",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A",
        "authorized_official_last_name": "BRANIGAN",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "631-451-7700"
    },
    "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": "Supersmiles Pediatric Dentistry IV",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medford, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2025; 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.