Provider Demographics
NPI:1518325703
Name:EXCELLENT DENTAL INC
Entity Type:Organization
Organization Name:EXCELLENT DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:MONZURUL
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-681-0020
Mailing Address - Street 1:1197 RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8005
Mailing Address - Country:US
Mailing Address - Phone:718-681-0020
Mailing Address - Fax:718-681-6373
Practice Address - Street 1:1197 RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8005
Practice Address - Country:US
Practice Address - Phone:718-681-0020
Practice Address - Fax:718-681-6373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty