Healthcare Provider Details

I. General information

NPI: 1942707773
Provider Name (Legal Business Name): KATIE PASSMAN DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE YOO DDS

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 COOPER ST
NEW YORK NY
10034-3818
US

IV. Provider business mailing address

6 W 77TH ST APT 7B
NEW YORK NY
10024-5125
US

V. Phone/Fax

Practice location:
  • Phone: 212-567-3368
  • Fax:
Mailing address:
  • Phone: 917-921-7584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number058175
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: