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General NPI Number Information
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NPI Number | 1538229539
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Entity Type | Organization
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Legal Business Name | NORTH-EAST DENTAL PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 405 LEXINGTON AVE
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City | NEW YORK
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State | NY
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Zip | 10174-0002
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Country | US
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Telephone | 646-706-7353
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Fax |
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Provider Business Mailing Address
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Address Line | 405 LEXINGTON AVE
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City | NEW YORK
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State | NY
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Zip | 10174-0002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COMMUNICATION OFFICIAL APPOINTED
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Name | MR. OWEN JONES
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Credential |
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Telephone | 646-706-7353
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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 | BM051437
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License Number State | NY
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