Provider Demographics
NPI:1275104887
Name:FORT WASHINGTON DENTAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:FORT WASHINGTON DENTAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-928-9000
Mailing Address - Street 1:130 FORT WASHINGTON AVE OFC 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4724
Mailing Address - Country:US
Mailing Address - Phone:212-928-9000
Mailing Address - Fax:
Practice Address - Street 1:130 FORT WASHINGTON AVE OFC 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4724
Practice Address - Country:US
Practice Address - Phone:212-928-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty