Provider Demographics
NPI:1497281422
Name:TANU PRAKASH DENTAL SERVICES, PC
Entity Type:Organization
Organization Name:TANU PRAKASH DENTAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANU
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAKASH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-749-2222
Mailing Address - Street 1:2090 7TH AVE
Mailing Address - Street 2:DENTAL STOREFRONT BEST DENTAL CARE NY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4990
Mailing Address - Country:US
Mailing Address - Phone:212-749-2222
Mailing Address - Fax:
Practice Address - Street 1:2090 7TH AVE
Practice Address - Street 2:DENTAL STOREFRONT BEST DENTAL CARE NY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4990
Practice Address - Country:US
Practice Address - Phone:212-749-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054540261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03188667Medicaid