Provider Demographics
NPI:1184030157
Name:72ND STREET DENTAL CARE PLLC
Entity Type:Organization
Organization Name:72ND STREET DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:CANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-744-7747
Mailing Address - Street 1:200 E 72ND ST
Mailing Address - Street 2:1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4537
Mailing Address - Country:US
Mailing Address - Phone:121-274-4774
Mailing Address - Fax:121-251-7267
Practice Address - Street 1:200 E 72ND ST
Practice Address - Street 2:1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4537
Practice Address - Country:US
Practice Address - Phone:121-274-4774
Practice Address - Fax:121-251-7267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046056122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty