MEDICARE: NYC DENTAL WELLNESS PLLC

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
1	1223G0001X	General Practice Dentistry	NY051000	NY
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1699050443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYC DENTAL WELLNESS PLLC

Provider Business Mailing Address
First Line	:	200 CENTRAL PARK S
Second Line	:	SUITE 109
City	:	NEW YORK
State	:	NY
Zip	:	10019-1449
Country	:	US
Telephone Number	:	212-750-3988
Fax Number	:	212-750-7102

Provider Business Practice Location Address
First Line	:	200 CENTRAL PARK S
Second Line	:	SUITE 109
City	:	NEW YORK
State	:	NY
Zip	:	10019-1449
Country	:	US
Telephone Number	:	212-750-3988
Fax Number	:	212-750-7102

Authorized Official
Title or Position	:	OWNER/DENTIST/PRESIDENT
Name	:	MS. MADALINA MARINA MANEA
Credential	:	DDS
Telephone Number	:	646-648-1287

Provider Enumeration Date	:	10/12/2011
Last Update Date	:	08/26/2022

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