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General NPI Number Information
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NPI Number | 1396138053
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Entity Type | Organization
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Legal Business Name | SOUTHWEST BROOKLYN DENTAL PRACTICE, PLLC
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 476 48TH ST 3RD FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11220-6844
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Country | US
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Telephone | 347-377-4485
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Fax | 718-630-8714
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Provider Business Mailing Address
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Address Line | 150 55TH ST
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City | BROOKLYN
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State | NY
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Zip | 11220-2508
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Country | US
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Telephone | 347-911-4485
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Fax | 718-630-8714
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Authorized Official
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Title or Position | PRESIDENT
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Name | BERNARD TOLPIN
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Credential | MD
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Telephone | 718-630-6866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 107698
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License Number State | NY
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