Provider Demographics
NPI:1144564048
Name:GROUP HEALTH DENTAL FACILITY
Entity Type:Organization
Organization Name:GROUP HEALTH DENTAL FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL/BILLING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:COMITTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-398-9690
Mailing Address - Street 1:230 W 41ST ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-7207
Mailing Address - Country:US
Mailing Address - Phone:212-398-9690
Mailing Address - Fax:646-607-2242
Practice Address - Street 1:230 W 41ST ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-7207
Practice Address - Country:US
Practice Address - Phone:212-398-9690
Practice Address - Fax:646-607-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty