| Greater Dental P.c. | |
|
1959a Westchester Ave Bronx NY 10462-4505 | |
| (718) 822-6086 | |
| (718) 822-6084 |
| Full Name | Greater Dental P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1959a Westchester Ave, Bronx, New York |
| Authorized Official Name and Position | Jessica Myae Lee (OWNER) |
| Authorized Official Contact | 7188226086 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Greater Dental P.c. 1959a Westchester Ave Bronx NY 10462-4505 Ph: (718) 822-6086 | Greater Dental P.c. 1959a Westchester Ave Bronx NY 10462-4505 Ph: (718) 822-6086 |
| NPI Number | 1639445745 |
|---|---|
| Provider Enumeration Date | 03/23/2012 |
| Last Update Date | 04/03/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639445745 | NPI | - | NPPES |
| 02902674 | Medicaid | NY | |
| 03466153 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 053612 (New York) | Primary |
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