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General NPI Number Information
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NPI Number | 1568908648
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Entity Type | Organization
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Legal Business Name | HARLEM DENTAL CARE PLLC
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Dates
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Enumeration Date | 01/12/2017
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 163 W 145TH ST
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City | NEW YORK
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State | NY
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Zip | 10039-4234
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Country | US
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Telephone | 212-281-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 163 W 145TH ST
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City | NEW YORK
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State | NY
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Zip | 10039-4234
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Country | US
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Telephone | 212-281-9200
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Fax |
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Authorized Official
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Title or Position | GENRAL DENTIST
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Name | DR. NAZAR SHCHEGLOV
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Credential | D.O
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Telephone | 212-281-9200
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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 | 0520941
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License Number State | NY
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