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General NPI Number Information
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NPI Number | 1871719070
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Entity Type | Individual
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Provider Name | MARK PHILIP DORN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 118 E 19TH ST
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City | NEW YORK
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State | NY
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Zip | 10003-2127
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Country | US
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Telephone | 212-979-6363
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Fax | 212-995-1916
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Provider Business Mailing Address
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Address Line | 333 E 53RD ST APT 6JKL
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City | NEW YORK
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State | NY
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Zip | 10022-4911
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Country | US
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Telephone | 212-688-1944
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Fax | 212-995-1916
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 033020
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License Number State | NY
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