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General NPI Number Information
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NPI Number | 1134465792
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Entity Type | Organization
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Legal Business Name | UPPER EAST SIDE DENTAL ARTS, PLLC
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Dates
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Enumeration Date | 12/28/2012
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Last Update Date | 12/28/2012
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Provider Practice Location Address
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Address Line | 130 E 63RD ST
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City | NEW YORK
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State | NY
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Zip | 10065-7334
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Country | US
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Telephone | 212-751-7725
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Fax | 212-751-7782
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Provider Business Mailing Address
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Address Line | 130 E 63RD ST
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City | NEW YORK
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State | NY
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Zip | 10065-7334
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Country | US
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Telephone | 212-751-7725
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Fax | 212-751-7782
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KONSTANTINE TRICHAS
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Credential | DDS
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Telephone | 212-751-7725
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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 | 054816-1
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License Number State | NY
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