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General NPI Number Information
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NPI Number | 1215486907
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Entity Type | Organization
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Legal Business Name | PARK AVENUE COMPREHENSIVE DENTISTRY, P.C.
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 230 PARK AVE SUITE 1166
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City | NEW YORK
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State | NY
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Zip | 10169-0005
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Country | US
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Telephone | 212-838-0053
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Fax | 212-697-3005
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Provider Business Mailing Address
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Address Line | 230 PARK AVE SUITE 1166
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City | NEW YORK
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State | NY
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Zip | 10169-0005
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Country | US
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Telephone | 212-838-0053
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Fax | 212-697-3005
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAN LINHART
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Credential | DMD
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Telephone | 212-838-0053
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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 | 034440
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License Number State | NY
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