Soul Dental West PLLC
Dentist, General Practice in New York, NY. Organization (NPI-2).
NPI number1083170021
StatusActive
Last updated in NPPESFeb 14, 2019
Details
- NPI
- 1083170021
- Entity type
- Organization (NPI-2)
- Legal business name
- Soul Dental West PLLC
- Organization subpart
- No
- Enumeration date
- Feb 14, 2019
- Last updated
- Feb 14, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Practice location
853 11th AveNew York, NY 10019
Phone 212-201-0718 · Fax 646-597-6068
Mailing address
853 11th AveNew York, NY 10019
Phone 212-201-0718 · Fax 646-597-6068
Authorized official
Alla Malanitcheva
Administrator
7189166748
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