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General NPI Number Information
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NPI Number | 1558781930
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Entity Type | Organization
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Legal Business Name | NY DENTAL GROUP, P.C.
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 35 E 38TH ST APT 1C
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City | NEW YORK
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State | NY
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Zip | 10016-2528
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Country | US
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Telephone | 212-776-4259
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Fax |
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Provider Business Mailing Address
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Address Line | 425 MADISON AVE
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City | NEW YORK
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State | NY
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Zip | 10017-1110
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Country | US
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Telephone | 212-752-1919
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RHONDA HAKIMI
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Credential |
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Telephone | 212-776-4259
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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 | 048051-1
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License Number State | NY
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