NPIMap

Organization Active NPI

Supersmiles KDS Dental PC

  • Pediatric Dentistry
  • Riverhead, NY
National Provider Identifier
1922586841
Registry record updated Feb 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
053121 Issued in NY
Legal business name
SUPERSMILES KDS DENTAL PC
Practice address
750 Roanoke Ave
Riverhead, NY 11901-2791
Phone
(631) 727-8585
Fax
(631) 727-8589
NPI assigned
Aug 2, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2025

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

Authorized official

Name
Mr. Paraskevas Kourtsounis, DDS
Title
Owner
Phone
(631) 451-7700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 053121 NY Primary

Addresses

Primary practice location

750 Roanoke Ave
Riverhead, NY 11901-2791

Mailing address

750 Roanoke Ave
Riverhead, NY 11901
Phone (631) 727-8585

Other names 1

  • SUNNY SMILES 4 KIDS 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.

Locations

750 Roanoke Ave
Riverhead, NY 11901
Phone (631) 727-8585

Practitioners & affiliated clinicians

Practitioners 2

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": "1533168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740355200000",
    "number": "1922586841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 ROANOKE AVE",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "11901",
            "telephone_number": "631-727-8585",
            "fax_number": "631-727-8589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 ROANOKE AVE",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012791",
            "telephone_number": "631-727-8585",
            "fax_number": "631-727-8589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERSMILES KDS DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-02",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A",
        "authorized_official_last_name": "KOURTSOUNIS",
        "authorized_official_first_name": "PARASKEVAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-451-7700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "053121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUNNY SMILES 4 KIDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverhead, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 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.