Organization
FRESH SMILES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA PITKOUVICH (COORDINATOR)
(917) 391-8000
Entity
Organization
Contact information
Practice address
6709 FRESH POND RD FL 2, RIDGEWOOD, NY 11385-4505
(718) 261-4000
Mailing address
6709 FRESH POND RD FL 2, RIDGEWOOD, NY 11385-4505
(718) 261-4000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
04/23/2025
Last updated
04/23/2025
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