Provider Demographics
NPI:1114223856
Name:SOUTH END DENTAL CENTER PC
Entity Type:Organization
Organization Name:SOUTH END DENTAL CENTER PC
Other - Org Name:SOUTH END DENTAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVTEJ
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-725-6638
Mailing Address - Street 1:13515 122ND ST
Mailing Address - Street 2:
Mailing Address - City:S OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3607
Mailing Address - Country:US
Mailing Address - Phone:646-725-6638
Mailing Address - Fax:
Practice Address - Street 1:34 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-7057
Practice Address - Country:US
Practice Address - Phone:646-725-6638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0098081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty