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General NPI Number Information
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NPI Number | 1295161164
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Entity Type | Organization
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Legal Business Name | HUERTA DENTISTRY, PC
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Dates
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Enumeration Date | 09/23/2013
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Last Update Date | 09/23/2013
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Provider Practice Location Address
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Address Line | 151 W 30TH ST SUITE 602
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City | NEW YORK
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State | NY
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Zip | 10001-4007
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Country | US
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Telephone | 646-649-3116
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Fax |
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Provider Business Mailing Address
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Address Line | 525 E 13TH ST 8C
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City | NEW YORK
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State | NY
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Zip | 10009-3579
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Country | US
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Telephone | 267-972-1020
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. CARLOS J. HUERTA
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Credential | DMD
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Telephone | 646-649-3116
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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 |
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License Number State |
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