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General NPI Number Information
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NPI Number | 1407087075
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Entity Type | Organization
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Legal Business Name | UPPER EAST SIDE DENTISTRY,PLLC
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Dates
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Enumeration Date | 07/30/2009
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Last Update Date | 07/30/2009
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Provider Practice Location Address
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Address Line | 175 E 74TH ST 1A
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City | NEW YORK
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State | NY
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Zip | 10021-3218
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Country | US
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Telephone | 212-737-1787
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Fax | 212-706-0197
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Provider Business Mailing Address
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Address Line | 175 E 74TH ST 1A
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City | NEW YORK
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State | NY
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Zip | 10021-3218
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Country | US
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Telephone | 212-737-1787
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Fax | 212-706-0197
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. FREDA SEIFODDINI
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Credential | DDS
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Telephone | 212-737-1787
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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 | 047925
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License Number State | NY
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