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General NPI Number Information
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NPI Number | 1063624518
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL ASSOCIATES
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Dates
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Enumeration Date | 05/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 30 E 40TH ST SUITE 503
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City | NEW YORK
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State | NY
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Zip | 10016-1201
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Country | US
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Telephone | 212-986-2039
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Fax | 212-532-2726
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Provider Business Mailing Address
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Address Line | 30 E 40TH ST SUITE 503
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City | NEW YORK
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State | NY
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Zip | 10016-1201
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Country | US
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Telephone | 212-986-2039
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Fax | 212-532-2726
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL S. KING
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Credential | D.D.S.
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Telephone | 212-986-2039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0033401
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License Number State | NY
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