Premium Smiles LLC

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

Legal business name

PREMIUM SMILES LLC

Practice address

1810 Harriet St
Elmont, NY 11003-4326

Phone

(718) 294-3725

NPI assigned

Sep 22, 2023

Organization subpart

No

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

Authorized official

Name

Alejandro Williams, DDS

Title

Owner

Phone

(718) 294-3725

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1695340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695340800000",
    "number": "1811776636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1097",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104531015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 HARRIET ST",
            "city": "ELMONT",
            "state": "NY",
            "postal_code": "110034326",
            "telephone_number": "718-294-3725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM SMILES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-22",
        "last_updated": "2023-09-22",
        "certification_date": "2023-09-22",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "ALEJANDRO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-294-3725",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery Clinic/Center in Elmont, NY
• Providers in Elmont, NY by specialty
• Oral and Maxillofacial Surgery Clinic/Center in New York

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