Provider Demographics
NPI:1427596857
Name:EDG DENTAL PC
Entity Type:Organization
Organization Name:EDG DENTAL PC
Other - Org Name:PARK NORTH DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:GILROY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-346-8194
Mailing Address - Street 1:31 EIGHTH AVENUE,SUITE #1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217
Mailing Address - Country:US
Mailing Address - Phone:917-346-8194
Mailing Address - Fax:
Practice Address - Street 1:31 EIGHTH AVENUE,SUITE #1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217
Practice Address - Country:US
Practice Address - Phone:917-346-8194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9352240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty