Provider Demographics
NPI:1033793997
Name:EAST VILLAGE DENTAL ARTS
Entity Type:Organization
Organization Name:EAST VILLAGE DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-979-6300
Mailing Address - Street 1:645 E 11TH ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-4134
Mailing Address - Country:US
Mailing Address - Phone:212-979-6300
Mailing Address - Fax:212-202-4173
Practice Address - Street 1:645 E 11TH ST APT 1F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-4134
Practice Address - Country:US
Practice Address - Phone:212-979-6300
Practice Address - Fax:212-202-4173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty