Organization
GREAT SMILE DENTAL SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRANKLIN L MARTINEZ DDS (PRESIDENT)
(212) 795-9519
Entity
Organization
Contact information
Practice address
629 W 185TH ST, 4TH FLOOR, NEW YORK, NY 10033-3102
(212) 795-9519
(646) 353-6482
Mailing address
629 W 185TH ST, 4TH FLOOR, NEW YORK, NY 10033-3102
(212) 795-9519
(646) 353-6482
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
050561-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02387915
—
NY
Enumeration date
08/07/2015
Last updated
08/07/2015
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