Provider Demographics
NPI:1235848862
Name:GPG DENTAL PLLC
Entity Type:Organization
Organization Name:GPG DENTAL PLLC
Other - Org Name:MADISON DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRATZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-532-1400
Mailing Address - Street 1:275 MADISON AVENUE
Mailing Address - Street 2:25TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-532-1400
Mailing Address - Fax:212-532-4655
Practice Address - Street 1:275 MADISON AVENUE
Practice Address - Street 2:25TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-532-1400
Practice Address - Fax:212-532-4655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GPG DENTAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-22
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty