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NPI Code Detail

MEDICARE: DENTAL SPECIALTY ASSOCIATES PC

MEDICARE: DENTAL SPECIALTY ASSOCIATES PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223S0112XOral and Maxillofacial Surgery (Dentist)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275592693
Entity Type Code : Organization
Provider Name (Legal Business Name) : DENTAL SPECIALTY ASSOCIATES PC
Provider Business Mailing Address
First Line : 225 BROADWAY
Second Line : SUITE #105
City : NEW YORK
State : NY
Zip : 10007-3001
Country : US
Telephone Number : 212-374-9500
Fax Number : 212-732-0267
Provider Business Practice Location Address
First Line : 225 BROADWAY
Second Line : SUITE #105
City : NEW YORK
State : NY
Zip : 10007-3001
Country : US
Telephone Number : 212-374-9500
Fax Number : 212-732-0267
Authorized Official
Title or Position : PRESIDENT
Name : DR. PAUL IRVING COHEN
Credential : DDS
Telephone Number : 212-374-9500
Provider Enumeration Date : 03/23/2006
Last Update Date : 08/22/2020

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Directions to “DENTAL SPECIALTY ASSOCIATES PC ” Practice Location

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