Provider Demographics
NPI:1053130567
Name:SMILE SPOT ORTHODONTICS PLLC
Entity type:Organization
Organization Name:SMILE SPOT ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-400-2479
Mailing Address - Street 1:14 THIELLS MOUNT IVY RD STE 103
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3021
Mailing Address - Country:US
Mailing Address - Phone:845-400-2479
Mailing Address - Fax:845-400-2537
Practice Address - Street 1:14 THIELLS MOUNT IVY RD STE 103
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3021
Practice Address - Country:US
Practice Address - Phone:845-400-2479
Practice Address - Fax:845-400-2537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty