Healthcare Provider Details

I. General information

NPI: 1346195526
Provider Name (Legal Business Name): TUDOR CITY DENTAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 E 41ST ST APT 101A
NEW YORK NY
10017-5977
US

IV. Provider business mailing address

304 E 41ST ST APT 101A
NEW YORK NY
10017-5977
US

V. Phone/Fax

Practice location:
  • Phone: 212-697-4690
  • Fax:
Mailing address:
  • Phone: 212-697-4690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARC WILK
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 212-697-4690