NPIMap

Organization Active NPI

Smiles on Broadway Dental Care, PLLC

  • Dentist
  • Malverne, NY
National Provider Identifier
1740319656
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
047179 Issued in NY
Legal business name
SMILES ON BROADWAY DENTAL CARE, PLLC
Practice address
116 Broadway
Malverne, NY 11565-1635
Phone
(516) 599-0883
Fax
(516) 599-0227
NPI assigned
Mar 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Dominique Lizzio, D.D.S.
Title
Co-President
Phone
(516) 599-0883

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 047179 NY Primary

Addresses

Primary practice location

116 Broadway
Malverne, NY 11565-1635

Mailing address

116 Broadway
Malverne, NY 11565-1635
Phone (516) 599-0883

National Provider Directory

National Provider Directory

Locations

116 Broadway
Malverne, NY 11565
Phone (516) 599-0883

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740319656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 BROADWAY",
            "city": "MALVERNE",
            "state": "NY",
            "postal_code": "115651635",
            "telephone_number": "516-599-0883",
            "fax_number": "516-599-0227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 BROADWAY",
            "city": "MALVERNE",
            "state": "NY",
            "postal_code": "115651635",
            "telephone_number": "516-599-0883",
            "fax_number": "516-599-0227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILES ON BROADWAY DENTAL CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LIZZIO",
        "authorized_official_first_name": "DOMINIQUE",
        "authorized_official_title_or_position": "CO-PRESIDENT",
        "authorized_official_telephone_number": "516-599-0883",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "047179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Malverne, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.