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General NPI Number Information
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NPI Number | 1578933305
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Entity Type | Organization
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Legal Business Name | EZ GENTLE FAMILY DENTAL, INC.
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Dates
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Enumeration Date | 10/06/2015
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Last Update Date | 10/06/2015
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Provider Practice Location Address
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Address Line | 4175 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10033-3730
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Country | US
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Telephone | 212-781-7272
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Fax | 212-781-2220
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Provider Business Mailing Address
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Address Line | 56 FERGUSON ST E-1
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City | NEWARK
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State | NJ
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Zip | 07105-2881
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Country | US
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Telephone |
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Fax | 973-878-2689
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Authorized Official
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Title or Position | OFFICE MANAGER/ADMINISTRATOR
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Name | MR. GEORGE D GUTIERREZ
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Credential |
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Telephone | 212-781-7272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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