Organization · NPI-2
573 Fordham Dental PC
Dentist, General Practice · Bronx, NY
NPI number1043634660
StatusActive
Last updated in NPPESFeb 18, 2014
Details
- NPI
- 1043634660
- Entity type
- Organization (NPI-2)
- Legal business name
- 573 Fordham Dental PC
- Organization subpart
- No
- Enumeration date
- Feb 18, 2014
- Last updated
- Feb 18, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Practice location
573 E Fordham RdBronx, NY 10458-5018
Phone 917-962-9990
Mailing address
573 E Fordham RdBronx, NY 10458-5018
Authorized official
Nina Otano
Office Manager
9179629990
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