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General NPI Number Information
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NPI Number | 1205066412
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Entity Type | Organization
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Legal Business Name | 23RD STREET DENTAL LLC
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 12/08/2015
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Provider Practice Location Address
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Address Line | 49 W 23RD ST 12TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10010-4206
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Country | US
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Telephone | 212-206-7215
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Fax | 212-206-1436
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Provider Business Mailing Address
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Address Line | 49 W 23RD ST 12TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10010-4206
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Country | US
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Telephone | 212-206-7215
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Fax | 212-206-1436
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Authorized Official
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Title or Position | MANAGER
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Name | DR. MARK S NADOLNE
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Credential | D.M.D.
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Telephone | 212-206-7215
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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 | 047883
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License Number State | NY
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