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NPI Code Detail

MEDICARE: MADISON DENTAL GROUP PC

MEDICARE: MADISON DENTAL GROUP PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry5001674NY

General Provider Information

NPI Number : 1073530093
Entity Type Code : Organization
Provider Name (Legal Business Name) : MADISON DENTAL GROUP PC
Provider Business Mailing Address
First Line : 515 MADISON AVE
Second Line : SUITE 3900
City : NEW YORK
State : NY
Zip : 10022-5403
Country : US
Telephone Number : 212-935-9300
Fax Number : 212-644-2062
Provider Business Practice Location Address
First Line : 515 MADISON AVE
Second Line : SUITE 3900
City : NEW YORK
State : NY
Zip : 10022-5403
Country : US
Telephone Number : 212-935-9300
Fax Number : 212-644-2062
Authorized Official
Title or Position : OWNER/DENTIST
Name : DR. GEORGE D RESKAKIS
Credential : D.D.S.
Telephone Number : 212-935-9300
Provider Enumeration Date : 07/16/2006
Last Update Date : 08/22/2020

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Directions to “MADISON DENTAL GROUP PC ” Practice Location

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