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General NPI Number Information
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NPI Number | 1487131009
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Entity Type | Organization
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Legal Business Name | SOUTH END DENTAL PC
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Dates
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Enumeration Date | 07/26/2018
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Last Update Date | 07/26/2018
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Provider Practice Location Address
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Address Line | 375 S END AVE STE 1B
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City | NEW YORK
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State | NY
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Zip | 10280-1014
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Country | US
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Telephone | 212-786-0930
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Fax | 212-656-1430
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Provider Business Mailing Address
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Address Line | 375 S END AVE STE 1B
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City | NEW YORK
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State | NY
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Zip | 10280-1014
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Country | US
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Telephone | 212-786-0930
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Fax | 212-656-1430
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | STEPHANIE ARIAS
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Credential |
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Telephone | 212-786-0930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State | NY
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