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General NPI Number Information
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NPI Number | 1124759527
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Entity Type | Organization
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Legal Business Name | 3545 JOHNSON BLVD DENTAL PC
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Dates
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Enumeration Date | 06/17/2022
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 1624 UNIVERSITY AVE BSMT
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City | BRONX
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State | NY
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Zip | 10453-6948
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Country | US
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Telephone | 718-294-3725
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Fax |
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Provider Business Mailing Address
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Address Line | 1624 UNIVERSITY AVE BSMT
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City | BRONX
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State | NY
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Zip | 10453-6948
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Country | US
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Telephone | 718-294-3725
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALEJANDRO LEONEL WILLIAMS
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Credential | DDS
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Telephone | 718-294-3725
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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 |
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License Number State |
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