125th St. Dental Group, PLLC
Dentist, Orthodontics and Dentofacial Orthopedics in New York, NY. Organization (NPI-2).
NPI number1134561137
StatusActive
Last updated in NPPESJul 19, 2013
Details
- NPI
- 1134561137
- Entity type
- Organization (NPI-2)
- Legal business name
- 125th St. Dental Group, PLLC
- Organization subpart
- No
- Enumeration date
- Jul 19, 2013
- Last updated
- Jul 19, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223X0400X | Dentist, Orthodontics and Dentofacial Orthopedics | 051019 | NY | Yes |
Other names
- 125 St. Braces (Doing Business As)
Practice location
63 W 125th St2nd Floor
New York, NY 10027-4512
Phone 646-505-8852
Mailing address
63 W 125th St2nd Floor
New York, NY 10027-4512
Phone 646-505-8852
Authorized official
Daniel Kuncio
Member
6465058852
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