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General NPI Number Information
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NPI Number | 1740604131
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Entity Type | Organization
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Legal Business Name | GREENWICH VILLAGE DENTAL ARTS PC
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Dates
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Enumeration Date | 02/06/2014
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Last Update Date | 02/06/2014
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Provider Practice Location Address
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Address Line | 55 EAST 9TH STREET
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City | NEW YORK
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State | NY
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Zip | 10003
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Country | US
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Telephone | 212-388-1170
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Fax | 212-388-1181
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Provider Business Mailing Address
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Address Line | 55 E 9TH ST
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City | NEW YORK
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State | NY
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Zip | 10003-6311
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Country | US
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Telephone | 212-388-1170
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Fax | 212-388-1181
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Authorized Official
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Title or Position | OWNER
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Name | DR. TODD D BERTMAN
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Credential | DMD
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Telephone | 212-388-1170
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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 | 048272
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License Number State | NY
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