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General NPI Number Information
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NPI Number | 1538378633
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Entity Type | Organization
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Legal Business Name | 2ND AVENUE TOOTH DOCTOR,PC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 1976 2ND AVE
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City | NEW YORK
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State | NY
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Zip | 10029
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Country | US
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Telephone | 212-996-6269
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Fax |
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Provider Business Mailing Address
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Address Line | 1976 2ND AVE
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City | NEW YORK
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State | NY
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Zip | 10029
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Country | US
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Telephone | 212-996-6269
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | GINA COLON
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Credential |
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Telephone | 212-996-6269
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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 |
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License Number State |
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