Organization · NPI-2

125th Street Dental LLP

Dentist, General Practice · New York, NY

NPI number1861523771
StatusActive
Last updated in NPPESAug 22, 2020

Details

NPI
1861523771
Entity type
Organization (NPI-2)
Legal business name
125th Street Dental LLP
Organization subpart
No
Enumeration date
Mar 9, 2007
Last updated
Aug 22, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice049097NYYes

Practice location

437 W 125th St
New York, NY 10027-4201

Phone 646-827-9819 · Fax 646-827-0510

Mailing address

437 W 125th St
New York, NY 10027-4201

Phone 646-827-9819 · Fax 646-827-0510

Authorized official

Serguei Kopetskov
President
6468279819

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