| Concourse Plaza Family Dental Llc | |
|
230 E 161st St Bronx NY 10451-3546 | |
| (718) 992-8200 | |
| (718) 537-4169 |
| Full Name | Concourse Plaza Family Dental Llc |
|---|---|
| Speciality | Dentist |
| Location | 230 E 161st St, Bronx, New York |
| Authorized Official Name and Position | Godrick Allister Taylor (OWNER) |
| Authorized Official Contact | 3472043362 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Concourse Plaza Family Dental Llc 230 E 161st St Bronx NY 10451-3546 Ph: (718) 992-8200 | Concourse Plaza Family Dental Llc 230 E 161st St Bronx NY 10451-3546 Ph: (718) 992-8200 |
| NPI Number | 1417325382 |
|---|---|
| Provider Enumeration Date | 09/09/2015 |
| Last Update Date | 09/09/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417325382 | NPI | - | NPPES |
| 02677278 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 052071 (New York) | Primary |
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