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General NPI Number Information
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NPI Number | 1972256469
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Entity Type | Organization
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Legal Business Name | 156 5TH AVE DENTAL PLLC
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Dates
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Enumeration Date | 02/03/2022
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 156 5TH AVE STE 900
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City | NEW YORK
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State | NY
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Zip | 10010-7763
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Country | US
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Telephone | 917-403-7806
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Fax |
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Provider Business Mailing Address
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Address Line | 44 W 22ND ST APT 3
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City | NEW YORK
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State | NY
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Zip | 10010-5859
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Country | US
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Telephone | 917-403-7806
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIDGET GLAZAROV
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Credential | DDS
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Telephone | 917-403-7806
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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 |
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License Number State |
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