Provider Demographics
NPI:1124554332
Name:CITIBRITES SURGICAL LLC
Entity Type:Organization
Organization Name:CITIBRITES SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NMM
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS ABOI
Authorized Official - Phone:718-727-0274
Mailing Address - Street 1:131 ARNOLD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2236
Mailing Address - Country:US
Mailing Address - Phone:718-727-0274
Mailing Address - Fax:
Practice Address - Street 1:131 ARNOLD ST FL 2
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2236
Practice Address - Country:US
Practice Address - Phone:718-727-0274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0409441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty