Provider Demographics
NPI:1164974846
Name:BROWNSTONE PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:BROWNSTONE PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:CORMAC
Authorized Official - Last Name:MACDERMONTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-855-2855
Mailing Address - Street 1:120 MONTAGUE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3482
Mailing Address - Country:US
Mailing Address - Phone:718-855-2855
Mailing Address - Fax:866-221-4121
Practice Address - Street 1:120 MONTAGUE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3482
Practice Address - Country:US
Practice Address - Phone:718-855-2855
Practice Address - Fax:866-221-4121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0524481223P0221X
NY0544121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty