Provider Demographics
NPI:1487288601
Name:BK SMILING DENTISTRY PLLC
Entity type:Organization
Organization Name:BK SMILING DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-395-3144
Mailing Address - Street 1:1035 FULTON ST.
Mailing Address - Street 2:STE 1, PO BOX 380530
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238
Mailing Address - Country:US
Mailing Address - Phone:717-395-3144
Mailing Address - Fax:
Practice Address - Street 1:1035 FULTON ST STE 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-5276
Practice Address - Country:US
Practice Address - Phone:717-395-3144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental