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General NPI Number Information
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NPI Number | 1124459706
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Entity Type | Organization
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Legal Business Name | ASTOR SMILE DENTAL PLLC
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Dates
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Enumeration Date | 12/06/2013
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Last Update Date | 12/06/2013
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Provider Practice Location Address
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Address Line | 191 3RD AVE
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City | NEW YORK
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State | NY
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Zip | 10003-2501
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Country | US
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Telephone | 212-254-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 191 3RD AVE
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City | NEW YORK
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State | NY
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Zip | 10003-2501
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Country | US
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Telephone | 212-254-0800
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. EUNJUNG JO
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Credential | D.D.S.
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Telephone | 212-254-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 056719
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License Number State | NY
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