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General NPI Number Information
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NPI Number | 1730725516
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Entity Type | Organization
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Legal Business Name | INTEGRATED ENDODONTICS PLLC
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Dates
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Enumeration Date | 11/27/2019
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Last Update Date | 11/27/2019
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Provider Practice Location Address
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Address Line | 355 OVINGTON AVE STE 101
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City | BROOKLYN
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State | NY
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Zip | 11209-1457
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Country | US
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Telephone | 718-833-2880
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Fax |
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Provider Business Mailing Address
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Address Line | 429 85TH ST
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City | BROOKLYN
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State | NY
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Zip | 11209-4705
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Country | US
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Telephone | 347-464-8378
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. WILSON DUONG
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Credential | DDS
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Telephone | 347-464-8378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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