| 12th Street Dental Pllc | |
|
77 E 12th St New York NY 10003-5002 | |
| (917) 915-4504 | |
| Not Available |
| Full Name | 12th Street Dental Pllc |
|---|---|
| Speciality | Dentist - Dental Public Health |
| Location | 77 E 12th St, New York, New York |
| Authorized Official Name and Position | David Janash (PRESIDENT AND CEO) |
| Authorized Official Contact | 9179154504 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 12th Street Dental Pllc 30 Central Park S Rm 13c New York NY 10019-1646 Ph: (212) 355-2000 | 12th Street Dental Pllc 77 E 12th St New York NY 10003-5002 Ph: (917) 915-4504 |
| NPI Number | 1013499052 |
|---|---|
| Provider Enumeration Date | 09/06/2018 |
| Last Update Date | 09/06/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013499052 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | 051610 (New York) | Primary |
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