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General NPI Number Information
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NPI Number | 1578713087
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Entity Type | Organization
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Legal Business Name | AESTHETIC CREATIONS DENTAL, P.L.L.C.
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Dates
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Enumeration Date | 09/22/2008
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 509 MADISON AVE SUITE 702
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City | NEW YORK
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State | NY
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Zip | 10022-5501
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Country | US
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Telephone | 212-688-0103
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Fax |
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Provider Business Mailing Address
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Address Line | 159 E 30TH ST #16A
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City | NEW YORK
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State | NY
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Zip | 10016-7300
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Country | US
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Telephone | 646-382-8443
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STELLA KYUNG-SEOK OH
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Credential | D.D.S.
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Telephone | 646-382-8443
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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 | 052746
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 052746
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License Number State | NY
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