| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 500 E 165th St, Bronx, New York |
| Authorized Official Name and Position | Edward Shalomov (PRESIDENT) |
| Authorized Official Contact | 7182907934 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
500 E 165th St Bronx NY 10456-6657 Ph: () - | 500 E 165th St Bronx NY 10456-6657 Ph: (347) 685-9525 |
| NPI Number | 1366880841 |
|---|---|
| Provider Enumeration Date | 06/06/2013 |
| Last Update Date | 06/06/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366880841 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 054092 (New York) | Primary |
| 261QD0000X | Clinic/center - Dental | 047852 (New York) | Secondary |
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