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General NPI Number Information
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NPI Number | 1215028428
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Entity Type | Organization
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Legal Business Name | DENTAL ARTS AT LEXINGTON & 63RD ST PC
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 105 E 63RD ST SUITE 1A-1B
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City | NEW YORK
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State | NY
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Zip | 10021-7329
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Country | US
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Telephone | 212-581-3030
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Fax | 212-207-8521
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Provider Business Mailing Address
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Address Line | 105 E 63RD ST SUITE 1A-1B
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City | NEW YORK
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State | NY
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Zip | 10021-7329
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Country | US
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Telephone | 212-581-3030
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Fax | 212-207-8521
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DR. CHARITO DELA CRUZ MORADA
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Credential | DDS
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Telephone | 212-581-3030
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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 | 0432701
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License Number State | NY
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