Provider Demographics
NPI:1073503215
Name:A. MASKELL D.D.S. AND S.MASKELL D.D.S., P.C.
Entity Type:Organization
Organization Name:A. MASKELL D.D.S. AND S.MASKELL D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASKELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-387-1365
Mailing Address - Street 1:722 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-4403
Mailing Address - Country:US
Mailing Address - Phone:718-387-1365
Mailing Address - Fax:718-486-5733
Practice Address - Street 1:722 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4403
Practice Address - Country:US
Practice Address - Phone:718-387-1365
Practice Address - Fax:718-486-5733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0267381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00904650Medicaid