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General NPI Number Information
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NPI Number | 1568702041
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Entity Type | Organization
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Legal Business Name | OPEN BRIGHT PEDIATRIC DENTISTRY P.C.
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Dates
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Enumeration Date | 02/21/2013
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Last Update Date | 02/21/2013
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Provider Practice Location Address
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Address Line | 131 W 110TH ST APT 1B
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City | NEW YORK
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State | NY
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Zip | 10026-4205
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Country | US
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Telephone | 347-292-1757
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Fax |
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Provider Business Mailing Address
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Address Line | 2266 5TH AVE UNIT 1695
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City | NEW YORK
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State | NY
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Zip | 10037-9464
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Country | US
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Telephone | 347-292-1757
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAURENCE HYACINTHE
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Credential | D.M.D.
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Telephone | 347-292-1757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 052837
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License Number State | NY
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