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General NPI Number Information
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NPI Number | 1891185245
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Entity Type | Organization
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Legal Business Name | 2090 DENTAL PC
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Dates
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Enumeration Date | 01/23/2015
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 2090 ADAM CLAYTON POWELL JR BLVD
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City | NEW YORK
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State | NY
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Zip | 10027-4990
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Country | US
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Telephone | 212-749-2222
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Fax | 212-749-2220
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Provider Business Mailing Address
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Address Line | 2090 ADAM CLAYTON POWELL JR BLVD
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City | NEW YORK
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State | NY
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Zip | 10027-4990
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Country | US
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Telephone | 212-749-2222
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Fax | 212-749-2220
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL P SYMEONIDES
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Credential | D.D.S.
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Telephone | 917-697-0845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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