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General NPI Number Information
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NPI Number | 1841550258
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Entity Type | Organization
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Legal Business Name | MIDWOOD ORTHODONTICS, PLLC
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Dates
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Enumeration Date | 05/18/2012
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Last Update Date | 05/18/2012
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Provider Practice Location Address
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Address Line | 977 E 12TH ST
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City | BROOKLYN
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State | NY
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Zip | 11230-3666
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Country | US
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Telephone | 718-336-6112
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Fax | 347-462-9337
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Provider Business Mailing Address
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Address Line | 977 E 12TH ST
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City | BROOKLYN
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State | NY
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Zip | 11230-3666
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Country | US
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Telephone | 718-336-6112
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Fax | 347-462-9337
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MAYA BERSHADSKY
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Credential | CDA
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Telephone | 718-336-6112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 028653
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License Number State | NY
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