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General NPI Number Information
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NPI Number | 1033793997
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Entity Type | Organization
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Legal Business Name | EAST VILLAGE DENTAL ARTS
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Dates
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Enumeration Date | 05/07/2021
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Last Update Date | 05/07/2021
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Provider Practice Location Address
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Address Line | 645 E 11TH ST APT 1F
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City | NEW YORK
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State | NY
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Zip | 10009-4134
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Country | US
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Telephone | 212-979-6300
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Fax | 212-202-4173
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Provider Business Mailing Address
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Address Line | 645 E 11TH ST APT 1F
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City | NEW YORK
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State | NY
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Zip | 10009-4134
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Country | US
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Telephone | 212-979-6300
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Fax | 212-202-4173
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS ANETTE LOPEZ
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Credential |
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Telephone | 212-979-6300
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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 |
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License Number State |
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