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General NPI Number Information
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NPI Number | 1790217933
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Entity Type | Organization
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Legal Business Name | MBP ORTHODONTICS
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 42 SHERWOOD PL
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City | GREENWICH
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State | CT
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Zip | 06830-5638
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Country | US
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Telephone | 203-900-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 42 SHERWOOD PLACE
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City | GREENWICH
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State | CT
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Zip | 06830
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Country | US
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Telephone | 203-900-1111
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BINA PARK
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Credential |
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Telephone | 212-369-2462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 050010-1
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License Number State | NY
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