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General NPI Number Information
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NPI Number | 1861944043
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Entity Type | Organization
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Legal Business Name | BP DENTISTRY FOR KIDS PC
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 5309 18TH AVE 2ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11204-1523
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Country | US
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Telephone | 718-644-0287
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Fax |
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Provider Business Mailing Address
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Address Line | 5309 18TH AVE 2ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11204-1523
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Country | US
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Telephone | 718-644-0287
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. ELLIOT LUTZ
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Credential | DDS
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Telephone | 347-244-2914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 057524
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 057648
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License Number State | NY
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