Simply Smile Dental PC

Primary specialty

DentistTaxonomy code 122300000X

License

053665 Issued in NY

Legal business name

SIMPLY SMILE DENTAL PC

Practice address

6222 Myrtle Ave
Glendale, NY 11385-6236

Phone

(718) 821-7432

NPI assigned

Feb 18, 2016

Last updated

Feb 18, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Juan Carlos Portela, DMDNPI 1952599649

Title

President

Phone

(347) 924-7736

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Juan Carlos Portela, DMD

  • Dentist
  • Schenectady, NY
  • NPI 1952599649
  NPD (past) Authorized official

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

{
    "created_epoch": "1455753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455753600000",
    "number": "1295194363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4545 CENTER BLVD APT 2908",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111095960",
            "telephone_number": "347-924-7736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6222 MYRTLE AVE",
            "city": "GLENDALE",
            "state": "NY",
            "postal_code": "113856236",
            "telephone_number": "718-821-7432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMPLY SMILE DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-18",
        "last_updated": "2016-02-18",
        "status": "A",
        "authorized_official_last_name": "PORTELA",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "CARLOS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "347-924-7736",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "053665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shoponline Pharmacy Inc (value healthcare pharmacy)
• Nausheen Siddiqui
• Mayelin Sierra
• Ksenia Simakina, RN
• Catherine Simon, RN
• SK Behavioral Services Inc
• Bridget Sowulski
• Melanie Anne Spall, DO
• Amanda Spang, PHARMD
• Kristen Michele Spang, MA, SLP, TSSLD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2016; 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.