Provider Demographics
NPI:1083192587
Name:IMPLANT DENTISTRY OF HARLEM PC
Entity Type:Organization
Organization Name:IMPLANT DENTISTRY OF HARLEM PC
Other - Org Name:HARLEM CENTER FOR AESTHETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-283-4800
Mailing Address - Street 1:470 LENOX AVE APT 1D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-3012
Mailing Address - Country:US
Mailing Address - Phone:212-283-4800
Mailing Address - Fax:
Practice Address - Street 1:470 LENOX AVE APT 1D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-3012
Practice Address - Country:US
Practice Address - Phone:212-283-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty