Healthcare Provider Details

I. General information

NPI: 1932579596
Provider Name (Legal Business Name): 505 DENTAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 CLAREMONT PKWY
BRONX NY
10457-8304
US

IV. Provider business mailing address

505 CLAREMONT PKWY
BRONX NY
10457-8304
US

V. Phone/Fax

Practice location:
  • Phone: 914-830-4804
  • Fax:
Mailing address:
  • Phone: 914-830-4804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number051-666
License Number StateNY

VIII. Authorized Official

Name: DR. JOHN G HABIB
Title or Position: MEMBER
Credential:
Phone: 914-830-4804