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General NPI Number Information
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NPI Number | 1477808087
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Entity Type | Organization
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Legal Business Name | NEW YORK CITY COSMETIC AND GENERAL DENTISTRY PC
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Dates
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Enumeration Date | 07/19/2012
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 119 W 57TH ST SUITE 512
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City | NEW YORK
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State | NY
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Zip | 10019-2303
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Country | US
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Telephone | 212-262-6054
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Fax |
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Provider Business Mailing Address
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Address Line | 119 W 57TH ST SUITE 512
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City | NEW YORK
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State | NY
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Zip | 10019-2303
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Country | US
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Telephone | 212-262-6054
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CATRISE AUSTIN
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Credential | DDS
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Telephone | 212-262-6054
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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 | 046889
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License Number State | NY
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