Provider Demographics
NPI:1023213337
Name:MONTEFIORE DENTAL DEPARTMENT
Entity Type:Organization
Organization Name:MONTEFIORE DENTAL DEPARTMENT
Other - Org Name:JARRETT DENTAL PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-920-4167
Mailing Address - Street 1:PO BOX 4156
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10261-4156
Mailing Address - Country:US
Mailing Address - Phone:718-920-4168
Mailing Address - Fax:718-515-5419
Practice Address - Street 1:1516 JARRET PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2607
Practice Address - Country:US
Practice Address - Phone:888-700-6623
Practice Address - Fax:718-515-5419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty