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General NPI Number Information
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NPI Number | 1245871029
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Entity Type | Organization
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Legal Business Name | NU DENTAL PC
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Dates
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Enumeration Date | 10/03/2019
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Last Update Date | 10/03/2019
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Provider Practice Location Address
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Address Line | 76 POND ST
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City | STATEN ISLAND
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State | NY
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Zip | 10309-1797
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Country | US
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Telephone | 718-568-0405
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Fax |
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Provider Business Mailing Address
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Address Line | 16 RIVERSIDE LN
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City | HOLMDEL
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State | NJ
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Zip | 07733-2084
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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 | OWNER/DIRECTOR
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Name | DR. ADMASU N GIZAHEW
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Credential | DDS
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Telephone | 718-568-0405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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