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General NPI Number Information
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NPI Number | 1053704544
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTAL AESTHETICS NY
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Dates
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Enumeration Date | 03/09/2015
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 30 E 60TH ST SUITE 1101
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City | NEW YORK
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State | NY
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Zip | 10022-1008
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Country | US
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Telephone | 212-421-8180
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Fax | 212-421-8182
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Provider Business Mailing Address
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Address Line | 901 E 14 MILE RD
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City | BIRMINGHAM
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State | MI
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Zip | 48009-2038
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Country | US
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Telephone | 212-421-8180
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Fax | 212-421-8182
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LOUIE KHOURI
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Credential | DDS
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Telephone | 212-421-8180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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