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General NPI Number Information
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NPI Number | 1184996282
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Entity Type | Organization
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Legal Business Name | DENTAL VISITS LLC
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Dates
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Enumeration Date | 02/03/2012
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | 30 E 40TH ST SUITE 604
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City | NEW YORK
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State | NY
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Zip | 10016-1201
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Country | US
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Telephone | 212-697-0939
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Fax |
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Provider Business Mailing Address
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Address Line | 30 E 40TH ST SUITE 604
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City | NEW YORK
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State | NY
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Zip | 10016-1201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | DR. JUDY JOHNSON
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Credential | DDS
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Telephone | 212-697-0939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 036361
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License Number State | NY
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