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General NPI Number Information
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NPI Number | 1912239336
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Entity Type | Organization
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Legal Business Name | BROOKLYN HEIGHTS PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 02/10/2010
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 148 ATLANTIC AVE
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City | BROOKLYN
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State | NY
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Zip | 11201-5586
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Country | US
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Telephone | 718-875-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 148 ATLANTIC AVE
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City | BROOKLYN
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State | NY
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Zip | 11201-5586
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JANICE LAU
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Credential |
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Telephone | 718-875-5437
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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 | 049299
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License Number State | NY
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