Provider Demographics
NPI:1306019088
Name:CARLOS M. OVALLE D.D.S.P.C
Entity Type:Organization
Organization Name:CARLOS M. OVALLE D.D.S.P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:OVALLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-927-1721
Mailing Address - Street 1:201 WADSWORTH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3862
Mailing Address - Country:US
Mailing Address - Phone:212-927-1721
Mailing Address - Fax:212-781-9600
Practice Address - Street 1:201 WADSWORTH AVE APT 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3862
Practice Address - Country:US
Practice Address - Phone:212-927-1721
Practice Address - Fax:212-781-9600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty