Provider Demographics
NPI:1255322061
Name:CITY DENTAL P.C.
Entity Type:Organization
Organization Name:CITY DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:TARANOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-425-0505
Mailing Address - Street 1:11 BROADWAY
Mailing Address - Street 2:MEZAN. LEVEL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1303
Mailing Address - Country:US
Mailing Address - Phone:212-425-0505
Mailing Address - Fax:212-425-2120
Practice Address - Street 1:11 BROADWAY
Practice Address - Street 2:MEZAN. LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1303
Practice Address - Country:US
Practice Address - Phone:212-425-0505
Practice Address - Fax:212-425-2120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049110-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty