| Columbus Avenue Dental Association | |
|
902 Columbus Ave New York NY 10025 | |
| (212) 749-5000 | |
| (212) 749-5522 |
| Full Name | Columbus Avenue Dental Association |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 902 Columbus Ave, New York, New York |
| Authorized Official Name and Position | Carol Poveda (PRESIDENT) |
| Authorized Official Contact | 2127495000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Columbus Avenue Dental Association 902 Columbus Ave New York NY 10025 Ph: (212) 749-5000 | Columbus Avenue Dental Association 902 Columbus Ave New York NY 10025 Ph: (212) 749-5000 |
| NPI Number | 1538367222 |
|---|---|
| Provider Enumeration Date | 07/05/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538367222 | NPI | - | NPPES |
| 02145435 | Medicaid | NY | |
| 01668193 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 046108 (New York) | Primary |
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