Organization · NPI-2

4th Avenue Dental

Dentist, General Practice · Brooklyn, NY

NPI number1295009447
StatusActive
Last updated in NPPESMar 6, 2012

Details

NPI
1295009447
Entity type
Organization (NPI-2)
Legal business name
4th Avenue Dental
Organization subpart
No
Enumeration date
Mar 6, 2012
Last updated
Mar 6, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice18369NJYes
1223G0001X Dentist, General Practice027990NY

Practice location

5404 4th Ave
Brooklyn, NY 11220-3006

Phone 718-439-2876 · Fax 718-439-2879

Mailing address

5404 4th Ave
Brooklyn, NY 11220-3006

Phone 718-439-2876 · Fax 718-439-2879

Authorized official

Andrew Maron
Owner
7184392876

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