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General NPI Number Information
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NPI Number | 1063658805
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Entity Type | Organization
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Legal Business Name | BLUE SKY DENTAL CENTER LLP
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Dates
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Enumeration Date | 12/29/2008
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Last Update Date | 12/29/2008
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Provider Practice Location Address
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Address Line | 210 CANAL ST #603
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City | NEW YORK
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State | NY
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Zip | 10013
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Country | US
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Telephone | 212-349-9682
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Fax | 212-349-1772
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Provider Business Mailing Address
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Address Line | 210 CANAL ST #603
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City | NEW YORK
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State | NY
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Zip | 10013
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Country | US
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Telephone | 212-349-9682
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Fax | 212-349-1772
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Authorized Official
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Title or Position | PARTNER
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Name | DR. KEVIN LEE CHAN
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Credential | DDS
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Telephone | 212-349-9682
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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 | NY044346
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | NY044175
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License Number State | NY
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