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General NPI Number Information
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NPI Number | 1427213891
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Entity Type | Organization
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Legal Business Name | MANHATTAN DENTAL ENTERPRISE, PLLC
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 1825 MADISON AVE
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City | NEW YORK
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State | NY
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Zip | 10035-3829
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Country | US
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Telephone | 212-426-3790
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Fax | 212-426-3792
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Provider Business Mailing Address
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Address Line | 1825 MADISON AVE
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City | NEW YORK
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State | NY
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Zip | 10035-3829
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Country | US
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Telephone | 212-426-3790
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Fax | 212-426-3792
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Authorized Official
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Title or Position | DDS
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Name | DR. LASAUNDRA C. ESTELLE
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Credential |
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Telephone | 212-426-3790
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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 | 052419
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License Number State | NY
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