Healthcare Provider Details

I. General information

NPI: 1679651079
Provider Name (Legal Business Name): WEBSTER DENTAL PLAZA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 WEBSTER AVE
BRONX NY
10456-3373
US

IV. Provider business mailing address

1231 WEBSTER AVE
BRONX NY
10456-3373
US

V. Phone/Fax

Practice location:
  • Phone: 646-402-8989
  • Fax: 646-402-8988
Mailing address:
  • Phone: 646-402-8989
  • Fax: 646-402-8988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60836
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60836
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number60836
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number60836
License Number StateNY

VIII. Authorized Official

Name: DR. MOHAMMADREZA ZARRINNEGAR
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 646-262-0113