NPIMap

Organization Active NPI

Supersmiles KDS Dental PC

Doing business as Supersmiles KDS IV

  • Pediatric Dentistry
  • Medford, NY
National Provider Identifier
1376336628
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
SUPERSMILES KDS DENTAL PC
Doing business as
Supersmiles KDS 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 Dentistry 1223P0221X NU 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 KDS IV Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Supersmiles KDS Dental PC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

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": "1376336628",
    "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 KDS DENTAL PC",
        "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": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Supersmiles KDS 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.