Organization
SUPERSMILES KDS DENTAL PC
Active
Other names
Supersmiles KDS IV
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE BRANIGAN (CREDENTIALING)
(631) 451-7700
Entity
Organization
Contact information
Practice address
1719 N OCEAN AVE STE C, MEDFORD, NY 11763-2669
(631) 289-0007
Mailing address
500 PORTION RD STE 16, RONKONKOMA, NY 11779-4587
(631) 451-7700
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
05/28/2025
Last updated
07/07/2025
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