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General NPI Number Information
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NPI Number | 1790174241
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Entity Type | Organization
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Legal Business Name | EMPIRE PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 12/30/2016
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Provider Practice Location Address
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Address Line | 365 W 25TH ST
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City | NEW YORK
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State | NY
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Zip | 10001-5803
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Country | US
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Telephone | 212-255-4337
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Fax |
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Provider Business Mailing Address
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Address Line | 365 W 25TH ST
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City | NEW YORK
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State | NY
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Zip | 10001-5803
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Country | US
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Telephone | 212-255-4337
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALICE LEE
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Credential | DDS
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Telephone | 212-255-4337
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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 | 048236
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License Number State | NY
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