Organization · NPI-2

1995 Broadway Dental Arts PLLC

Dentist · New York, NY

NPI number1144697368
StatusActive
Last updated in NPPESAug 24, 2015

Details

NPI
1144697368
Entity type
Organization (NPI-2)
Legal business name
1995 Broadway Dental Arts PLLC
Organization subpart
No
Enumeration date
Aug 24, 2015
Last updated
Aug 24, 2015

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
122300000X Dentist040754NYYes

Practice location

1995 Broadway
New York, NY 10023-5882

Phone 212-247-2330

Mailing address

1995 Broadway
New York, NY 10023-5882

Phone 212-247-2330

Authorized official

Marc Liechtung
President
7326108265

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