Healthcare Provider Details

I. General information

NPI: 1770795528
Provider Name (Legal Business Name): JOHN D KARLE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 LEXINGTON AVE
NEW YORK NY
10021-3274
US

IV. Provider business mailing address

1065 LEXINGTON AVE
NEW YORK NY
10021-3274
US

V. Phone/Fax

Practice location:
  • Phone: 212-861-7550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number028655
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: