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Organization
MY SMILES DENTAL PC
Active
Organization
MY SMILES DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRIGORIY YUSUPOV MD (OWNER)
(718) 232-6996
Entity
Organization
Contact information
Practice address
2101 BAY RIDGE PKWY # C, BROOKLYN, NY 11204-5955
(212) 332-6996
Mailing address
2101 BAY RIDGE PKWY # C, BROOKLYN, NY 11204-5955
(212) 332-6996
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/30/2021
Last updated
09/30/2021
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