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General NPI Number Information
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NPI Number | 1417027756
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Entity Type | Organization
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Legal Business Name | COMMUNITY DENTAL ASSOCIATES PC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 133 E 54TH ST SUITE 2C
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City | NEW YORK
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State | NY
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Zip | 10022-4538
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Country | US
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Telephone | 212-755-1637
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Fax | 212-371-0557
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Provider Business Mailing Address
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Address Line | 133 E 54TH ST SUITE 2C
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City | NEW YORK
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State | NY
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Zip | 10022-4538
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Country | US
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Telephone | 212-755-1637
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Fax | 212-371-0557
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Authorized Official
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Title or Position | PROSTHODONTIST
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Name | DR. EDWARD A WOODS
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Credential | DDS FAAHD
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Telephone | 212-755-1637
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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 | 026694
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License Number State | NY
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