Organization · NPI-2
5th Avenue Dental Assoc LLP
Dentist · Brooklyn, NY
NPI number1184742298
StatusActive
Last updated in NPPESSep 8, 2020
Details
- NPI
- 1184742298
- Entity type
- Organization (NPI-2)
- Legal business name
- 5th Avenue Dental Assoc LLP
- Organization subpart
- No
- Enumeration date
- Mar 27, 2007
- Certification date
- Sep 8, 2020
- Last updated
- Sep 8, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | – | – | Yes |
| 332BC3200X | Durable Medical Equipment & Medical Supplies, Customized Equipment | – | – |
Practice location
7815 5th AveBrooklyn, NY 11209-3703
Phone 718-745-4422 · Fax 718-745-8558
Mailing address
7815 5th AveBrooklyn, NY 11209-3703
Phone 718-745-4422 · Fax 718-745-8558
Authorized official
George Diacoumakos
Owner
7187454422
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