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General NPI Number Information
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NPI Number | 1649796491
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Entity Type | Organization
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Legal Business Name | CENTRAL PARK DENTISTRY, PC
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 30 CENTRAL PARK S RM 2B-2C
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City | NEW YORK
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State | NY
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Zip | 10019-1628
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Country | US
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Telephone | 212-486-6211
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Fax |
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Provider Business Mailing Address
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Address Line | 30 CENTRAL PARK S RM 2B-2C
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City | NEW YORK
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State | NY
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Zip | 10019-1628
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Country | US
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Telephone | 212-486-6211
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FRANK DICICCO
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Credential | DMD
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Telephone | 212-486-6211
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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 |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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