| Modern Orthodontics, Pc | |
|
391 E 149th St Rm 214 Bronx NY 10455-3922 | |
| (718) 993-5454 | |
| (718) 993-5455 |
| Full Name | Modern Orthodontics, Pc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 391 E 149th St Rm 214, Bronx, New York |
| Authorized Official Name and Position | Kenneth Bruce Cooperman (OWNER) |
| Authorized Official Contact | 7189935454 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Orthodontics, Pc 391 E 149th St Rm 214 Bronx NY 10455-3922 Ph: (718) 993-5454 | Modern Orthodontics, Pc 391 E 149th St Rm 214 Bronx NY 10455-3922 Ph: (718) 993-5454 |
| NPI Number | 1952366973 |
|---|---|
| Provider Enumeration Date | 04/20/2006 |
| Last Update Date | 05/14/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952366973 | NPI | - | NPPES |
| 200698105 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 0469571 (New York) | Primary |
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