Healthcare Provider Details

I. General information

NPI: 1275007908
Provider Name (Legal Business Name): MILDRED EMBREE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 W 51ST ST
NEW YORK NY
10019-6113
US

IV. Provider business mailing address

51 W 51ST ST
NEW YORK NY
10019-6113
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-3348
  • Fax:
Mailing address:
  • Phone: 212-305-3348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number060140-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: