Provider Demographics
NPI:1356097869
Name:43 CHRUCH STREET DENTAL PC
Entity Type:Organization
Organization Name:43 CHRUCH STREET DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELICIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPAILLAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-271-4840
Mailing Address - Street 1:1776 BOSTON RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-4907
Mailing Address - Country:US
Mailing Address - Phone:347-271-4840
Mailing Address - Fax:
Practice Address - Street 1:1776 BOSTON RD STE 1A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4907
Practice Address - Country:US
Practice Address - Phone:347-271-4840
Practice Address - Fax:347-271-4842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental