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General NPI Number Information
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NPI Number | 1457887861
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Entity Type | Organization
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Legal Business Name | MADISON AVENUE DENTAL STUDIO
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 424 MADISON AVE SUITE 1407
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City | NEW YORK
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State | NY
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Zip | 10017-1137
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Country | US
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Telephone | 212-838-2829
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Fax |
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Provider Business Mailing Address
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Address Line | 424 MADISON AVE SUITE 1407
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City | NEW YORK
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State | NY
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Zip | 10017-1137
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Country | US
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Telephone | 212-838-2829
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JULIE HASSID
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Credential | DMD
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Telephone | 212-838-2829
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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 | 054239
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License Number State | NY
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