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General NPI Number Information
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NPI Number | 1770977506
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Entity Type | Organization
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Legal Business Name | PARK DENTISTRY
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 55 8TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11217-3912
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Country | US
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Telephone | 718-622-7275
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Fax | 718-622-7276
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Provider Business Mailing Address
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Address Line | 55 8TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11217-3912
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Country | US
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Telephone | 718-622-7275
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Fax | 718-622-7276
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Authorized Official
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Title or Position | OWNER
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Name | DR. SOPHIA MILITO
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Credential |
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Telephone | 718-622-7275
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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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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