Provider Demographics
NPI:1477438869
Name:SMITH HAVEN DENTAL PLLC
Entity type:Organization
Organization Name:SMITH HAVEN DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-667-5595
Mailing Address - Street 1:112 ALEXANDER AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-0429
Mailing Address - Country:US
Mailing Address - Phone:631-212-8400
Mailing Address - Fax:631-212-8433
Practice Address - Street 1:112 ALEXANDER AVE UNIT A
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-0429
Practice Address - Country:US
Practice Address - Phone:631-212-8400
Practice Address - Fax:631-212-8433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty