=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518089473
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AAA DENTAL PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2007
-----------------------------------------------------
Last Update Date | 02/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 62 WEST 48TH STREET 2ND FL
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-869-3131
-----------------------------------------------------
Fax | 212-869-2756
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 62 WEST 48TH STREET 2ND FL
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-869-3131
-----------------------------------------------------
Fax | 212-869-2756
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | ALLA TEMKIN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 212-869-3131
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 045471
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 045041
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------