Provider Demographics
NPI:1043714579
Name:ANNA MELISSA CONCEPCION, D.M.D., P.C.
Entity Type:Organization
Organization Name:ANNA MELISSA CONCEPCION, D.M.D., P.C.
Other - Org Name:CONCEPT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONCEPCION
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-832-4110
Mailing Address - Street 1:158 E 58TH ST
Mailing Address - Street 2:SUITE 412
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-0002
Mailing Address - Country:US
Mailing Address - Phone:212-832-4110
Mailing Address - Fax:212-697-1289
Practice Address - Street 1:158 E 58TH ST
Practice Address - Street 2:SUITE 412
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-0002
Practice Address - Country:US
Practice Address - Phone:212-832-4110
Practice Address - Fax:212-697-1289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0531511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty