| 174 Street Dental Llc | |
|
146 E 174th St Bronx NY 10457-6904 | |
| (213) 709-7154 | |
| Not Available |
| Full Name | 174 Street Dental Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 146 E 174th St, Bronx, New York |
| Authorized Official Name and Position | Justin Sycamore (DENTIST) |
| Authorized Official Contact | 2137097154 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 174 Street Dental Llc 146 E 174th St Bronx NY 10457-6904 Ph: () - | 174 Street Dental Llc 146 E 174th St Bronx NY 10457-6904 Ph: (213) 709-7154 |
| NPI Number | 1134358427 |
|---|---|
| Provider Enumeration Date | 07/08/2009 |
| Last Update Date | 07/08/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134358427 | NPI | - | NPPES |
| 02861549 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 053429 (New York) | Primary |
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