Provider Demographics
NPI:1083883631
Name:CLAUDE FAMLY DENTISTRY P.C.
Entity Type:Organization
Organization Name:CLAUDE FAMLY DENTISTRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:HULDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLAUDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-935-9946
Mailing Address - Street 1:155 SMITH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6337
Mailing Address - Country:US
Mailing Address - Phone:718-935-9946
Mailing Address - Fax:718-935-9947
Practice Address - Street 1:155 SMITH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6337
Practice Address - Country:US
Practice Address - Phone:718-935-9946
Practice Address - Fax:718-935-9947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0456181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY8414OtherDORAL PAYEE
NY01751293Medicaid