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General NPI Number Information
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NPI Number | 1275049553
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Entity Type | Organization
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Legal Business Name | MANHATTAN OASIS DENTISTRY PC
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 06/04/2019
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Provider Practice Location Address
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Address Line | 525 W END AVE APT 1G
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City | NEW YORK
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State | NY
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Zip | 10024-3268
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Country | US
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Telephone | 212-874-2880
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Fax |
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Provider Business Mailing Address
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Address Line | 525 W END AVE APT 1G
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City | NEW YORK
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State | NY
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Zip | 10024-3268
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Country | US
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Telephone | 212-874-2880
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | JONATHAN MICHAEL RICHTER
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Credential | D.D.S., F.A.G.D.
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Telephone | 212-874-2880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 042221
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License Number State | NY
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