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General NPI Number Information
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NPI Number | 1417374182
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Entity Type | Organization
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Legal Business Name | W DENTAL
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 706 ST. NICHOLAS AVE
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City | NEW YORK
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State | NY
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Zip | 10031
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Country | US
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Telephone | 212-939-9399
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Fax | 212-939-9366
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Provider Business Mailing Address
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Address Line | 706 ST. NICHOLAS AVE
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City | NEW YORK
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State | NY
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Zip | 10031
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Country | US
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Telephone | 212-939-9399
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Fax | 212-939-9366
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Authorized Official
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Title or Position | D.M.D.
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Name | MR. GEORGE A WILLIAMS JR.
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Credential | DMD
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Telephone | 212-939-9399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 36042-1
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License Number State | NY
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