Provider Demographics
NPI:1427220540
Name:BRUCKNER PLAZA DENTAL SERVICE
Entity Type:Organization
Organization Name:BRUCKNER PLAZA DENTAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BEATUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-823-3393
Mailing Address - Street 1:1967 TURNBULL AVE STE 21A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2519
Mailing Address - Country:US
Mailing Address - Phone:718-823-3393
Mailing Address - Fax:
Practice Address - Street 1:1967 TURNBULL AVE STE 21A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2519
Practice Address - Country:US
Practice Address - Phone:718-823-3393
Practice Address - Fax:718-823-3449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0397691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty