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General NPI Number Information
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NPI Number | 1679868905
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Entity Type | Organization
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Legal Business Name | HARLEM GENTLE DENTAL PC
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 06/15/2011
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Provider Practice Location Address
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Address Line | 55 E 115TH ST
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City | NEW YORK
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State | NY
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Zip | 10029-1178
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Country | US
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Telephone | 212-470-6660
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Fax |
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Provider Business Mailing Address
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Address Line | 1340 E 40TH ST
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City | BROOKLYN
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State | NY
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Zip | 11234-2903
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Country | US
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Telephone | 917-604-6748
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Fax | 888-864-8390
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONELLE COX
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Credential | DDS
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Telephone | 917-604-6748
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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 | 054522
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License Number State | NY
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