Provider Demographics
NPI:1174132880
Name:BIG LITTLE SMILES PEDIATRIC DENTISTRY PLLC
Entity type:Organization
Organization Name:BIG LITTLE SMILES PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST - OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:VERA-CARABALLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:516-602-9500
Mailing Address - Street 1:2315 ASTORIA BLVD APT 5E
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-4461
Mailing Address - Country:US
Mailing Address - Phone:516-602-9500
Mailing Address - Fax:
Practice Address - Street 1:95 MORGAN ST APT 1A
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5411
Practice Address - Country:US
Practice Address - Phone:516-602-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty