Provider Demographics
NPI:1457468555
Name:MONICA M. GADIDOV, DENTIST P.C.
Entity Type:Organization
Organization Name:MONICA M. GADIDOV, DENTIST P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:MIHAILA
Authorized Official - Last Name:GADIDOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-685-9243
Mailing Address - Street 1:155 E 38TH ST.
Mailing Address - Street 2:# 2F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-685-9243
Mailing Address - Fax:212-685-9243
Practice Address - Street 1:155 E 38TH S.T
Practice Address - Street 2:# 2F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-685-9243
Practice Address - Fax:212-685-9243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0366601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty