Healthcare Provider Details

I. General information

NPI: 1144854431
Provider Name (Legal Business Name): NY METRO DENTAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MOSHOLU PARKWAY NORTH
BRONX NY
10467
US

IV. Provider business mailing address

330 WHITNEY AVE STE 740
HOLYOKE MA
01040-2789
US

V. Phone/Fax

Practice location:
  • Phone: 413-382-7022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: AMY CADIEUX
Title or Position: REG MGR
Credential:
Phone: 413-382-7022