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General NPI Number Information
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NPI Number | 1841314010
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Entity Type | Organization
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Legal Business Name | PRAISE THE LORD DENTAL,P.C.
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 122 LA SALLE ST
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City | NEW YORK
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State | NY
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Zip | 10027-4625
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Country | US
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Telephone | 212-866-1313
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Fax | 212-866-2061
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Provider Business Mailing Address
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Address Line | 122 LA SALLE ST
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City | NEW YORK
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State | NY
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Zip | 10027-4625
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Country | US
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Telephone | 212-866-1313
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Fax | 212-866-2061
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Authorized Official
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Title or Position | OWNER
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Name | JACINTO ALONZO MARTINEZ
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Credential | DDS
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Telephone | 212-866-1313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 046959
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License Number State | NY
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