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General NPI Number Information
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NPI Number | 1841486669
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Entity Type | Organization
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Legal Business Name | AMERICAN DENTAL ARTS
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Dates
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Enumeration Date | 09/16/2007
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 420 W 23RD ST # 1F
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City | NEW YORK
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State | NY
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Zip | 10011-2172
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Country | US
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Telephone | 212-929-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 281 CORBIN PL
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City | BROOKLYN
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State | NY
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Zip | 11235-4901
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Country | US
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Telephone | 212-929-9200
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ELIZABETH POLIN
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Credential | DDS
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Telephone | 212-929-9200
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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 | 0453491
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License Number State | NY
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