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General NPI Number Information
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NPI Number | 1528448594
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Entity Type | Organization
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Legal Business Name | PG DENTAL
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 18 E 50TH ST FL 8
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City | NEW YORK
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State | NY
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Zip | 10022-9110
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Country | US
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Telephone | 212-644-2822
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Fax |
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Provider Business Mailing Address
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Address Line | 18 E 50TH ST FL 8
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City | NEW YORK
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State | NY
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Zip | 10022-9110
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Country | US
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Telephone | 212-644-2822
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. PARIA GOODARZI
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Credential | DDS
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Telephone | 212-203-6538
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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 | 056750
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License Number State | NY
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