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General NPI Number Information
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NPI Number | 1720888910
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Entity Type | Organization
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Legal Business Name | MANHATTAN PARK DENTAL, PLLC
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 30 CENTRAL PARK S RM 11C
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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 | 212-702-8675
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Fax | 212-702-8675
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Provider Business Mailing Address
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Address Line | 30 CENTRAL PARK S RM 11C
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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 | 212-702-8675
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Fax | 212-702-8675
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CAMILLE SUZETTE SAN MIGUEL
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Credential | DDS
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Telephone | 240-491-7171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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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 | 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 #3
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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 #4
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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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