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NPI Code Detail

MEDICARE: 505 DENTAL ASSOCIATES PLLC

MEDICARE: 505 DENTAL ASSOCIATES PLLC
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
1122300000XDentist051-666NY

General Provider Information

NPI Number : 1932579596
Entity Type Code : Organization
Provider Name (Legal Business Name) : 505 DENTAL ASSOCIATES PLLC
Provider Business Mailing Address
First Line : 505 CLAREMONT PKWY
Second Line :
City : BRONX
State : NY
Zip : 10457-8304
Country : US
Telephone Number : 914-830-4804
Fax Number :
Provider Business Practice Location Address
First Line : 505 CLAREMONT PKWY
Second Line :
City : BRONX
State : NY
Zip : 10457-8304
Country : US
Telephone Number : 914-830-4804
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : DR. JOHN G HABIB
Credential :
Telephone Number : 914-830-4804
Provider Enumeration Date : 09/25/2015
Last Update Date : 09/25/2015

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