Provider Demographics
NPI:1275790594
Name:WADSWORTH FAMILY DENTISTRY, P.C.
Entity Type:Organization
Organization Name:WADSWORTH FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NINGSHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-795-4475
Mailing Address - Street 1:341A WADSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3143
Mailing Address - Country:US
Mailing Address - Phone:212-795-4475
Mailing Address - Fax:212-928-3650
Practice Address - Street 1:341A WADSWORTH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3143
Practice Address - Country:US
Practice Address - Phone:212-795-4475
Practice Address - Fax:212-928-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051417-1261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02656077Medicaid