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General NPI Number Information
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NPI Number | 1033408174
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Entity Type | Organization
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Legal Business Name | DYCKMAN DENTAL ARTS,PC
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Dates
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Enumeration Date | 03/29/2011
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Last Update Date | 03/29/2011
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Provider Practice Location Address
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Address Line | 177 DYCKMAN ST
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City | NEW YORK
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State | NY
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Zip | 10040-1069
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Country | US
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Telephone | 191-782-6904
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Fax |
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Provider Business Mailing Address
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Address Line | 177 DYCKMAN ST
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City | NEW YORK
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State | NY
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Zip | 10040-1069
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Country | US
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Telephone | 191-782-6904
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHAUL HUBSCHER
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Credential | DDS
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Telephone | 19178269045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 052971
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License Number State | NY
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