Provider Demographics
NPI:1508340662
Name:NEW YORK TOTAL DENTAL PLLC
Entity Type:Organization
Organization Name:NEW YORK TOTAL DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZAHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGHERI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-535-1068
Mailing Address - Street 1:180 NASSAU ST APT 8A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2198
Mailing Address - Country:US
Mailing Address - Phone:781-535-1068
Mailing Address - Fax:
Practice Address - Street 1:30 E 40TH ST RM 201
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1221
Practice Address - Country:US
Practice Address - Phone:781-535-1068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental