Provider Demographics
NPI:1376177782
Name:PCO ORTHO LLC
Entity Type:Organization
Organization Name:PCO ORTHO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TATIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:UNGPHAKORN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-496-6696
Mailing Address - Street 1:301 E 22ND ST APT 9M
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4821
Mailing Address - Country:US
Mailing Address - Phone:646-496-6696
Mailing Address - Fax:
Practice Address - Street 1:3422 35TH ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-1268
Practice Address - Country:US
Practice Address - Phone:646-496-6696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty