Healthcare Provider Details

I. General information

NPI: 1255321857
Provider Name (Legal Business Name): LORDER HUANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 E BROADWAY 3RD FLOOR
NEW YORK NY
10002-6803
US

IV. Provider business mailing address

28 E BROADWAY
NEW YORK NY
10002-6803
US

V. Phone/Fax

Practice location:
  • Phone: 212-965-9531
  • Fax: 212-965-9124
Mailing address:
  • Phone: 212-965-9531
  • Fax: 212-965-9124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number046034
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: