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General NPI Number Information
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NPI Number | 1962513986
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Entity Type | Organization
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Legal Business Name | TRIBECA DENTAL ASSOCIATE, PC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 11/04/2015
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Provider Practice Location Address
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Address Line | 21 MURRAY ST FLOOR 4
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City | NEW YORK
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State | NY
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Zip | 10007-2239
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Country | US
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Telephone | 212-346-0893
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Fax | 212-346-0894
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Provider Business Mailing Address
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Address Line | 21 MURRAY STREET FLOOR 4
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City | NEW YORK
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State | NY
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Zip | 10007
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Country | US
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Telephone | 212-346-0893
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Fax | 212-346-0894
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Authorized Official
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Title or Position | PRESIDENT
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Name | BAHRAM HAMIDI
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Credential | DDS
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Telephone | 212-346-0893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 048739
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 047254
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 0472584
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License Number State | NY
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