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NPI Code Detail

MEDICARE: AVENUE U DENTAL ARTS

MEDICARE: AVENUE U DENTAL ARTS
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
1122300000XDentistNY

General Provider Information

NPI Number : 1538528625
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVENUE U DENTAL ARTS
Provider Business Mailing Address
First Line : 1912 AVENUE U
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-3911
Country : US
Telephone Number : 718-648-3434
Fax Number : 718-648-1515
Provider Business Practice Location Address
First Line : 1912 AVENUE U
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-3911
Country : US
Telephone Number : 718-648-3434
Fax Number : 718-648-1515
Authorized Official
Title or Position : PRESIDENT
Name : DR. MARC LIECHTUNG
Credential : D.M.D.
Telephone Number : 718-648-3434
Provider Enumeration Date : 02/17/2016
Last Update Date : 02/17/2016

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Directions to “AVENUE U DENTAL ARTS ” Practice Location

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