Organization · NPI-2

12th Street Dental PLLC

Dentist, Dental Public Health · New York, NY

NPI number1013499052
StatusActive
Last updated in NPPESMay 30, 2024

Details

NPI
1013499052
Entity type
Organization (NPI-2)
Legal business name
12th Street Dental PLLC
Organization subpart
No
Enumeration date
Sep 6, 2018
Certification date
May 30, 2024
Last updated
May 30, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223D0001X Dentist, Dental Public Health051610NYYes

Practice location

77 E 12th St
New York, NY 10003-5002

Phone 917-915-4504

Mailing address

30 Central Park S Rm 13c
New York, NY 10019-1646

Phone 212-355-2000

Authorized official

David Janash
President And Ceo
9179154504

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