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General NPI Number Information
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NPI Number | 1639435290
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Entity Type | Organization
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Legal Business Name | ACCESS DENTAL GROUP MANHATTAN PLLC
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 139 CENTRE ST #322
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City | NEW YORK
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State | NY
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Zip | 10013-4552
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Country | US
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Telephone | 212-240-0028
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Fax | 212-240-0035
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Provider Business Mailing Address
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Address Line | 139 CENTRE ST #322
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City | NEW YORK
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State | NY
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Zip | 10013-4552
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Country | US
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Telephone | 212-240-0028
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Fax | 212-240-0035
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SIMON CHEUNG
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Credential | D.D.S.
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Telephone | 212-240-0028
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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 | 053008
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License Number State | NY
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