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General NPI Number Information
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NPI Number | 1184030157
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Entity Type | Organization
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Legal Business Name | 72ND STREET DENTAL CARE PLLC
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 200 E 72ND ST 1
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City | NEW YORK
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State | NY
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Zip | 10021-4537
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Country | US
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Telephone | 121-274-4774
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Fax | 121-251-7267
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Provider Business Mailing Address
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Address Line | 200 E 72ND ST 1
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City | NEW YORK
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State | NY
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Zip | 10021-4537
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Country | US
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Telephone | 121-274-4774
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Fax | 121-251-7267
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Authorized Official
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Title or Position | OWNER
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Name | DR. IAN MORGAN CANTOR
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Credential | DDS
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Telephone | 212-744-7747
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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 | 046056
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License Number State | NY
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