Organization
ORTHODONTICS AT JACKSON HEIGHTS SMILES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAJU MATHEW D.D.S. (OWNER)
(631) 235-9007
Entity
Organization
Contact information
Practice address
3062 79TH ST, 2ND FLOOR, EAST ELMHURST, NY 11370-1510
(718) 426-9400
(718) 426-9497
Mailing address
210 W 70TH ST, APT 1101, NEW YORK, NY 10023-4304
(631) 235-9007
(212) 954-5583
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
050711
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03128301
—
NY
Enumeration date
04/10/2014
Last updated
05/29/2014
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