Provider Demographics
NPI:1558781930
Name:NY DENTAL GROUP, P.C.
Entity Type:Organization
Organization Name:NY DENTAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKIMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-776-4259
Mailing Address - Street 1:425 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1110
Mailing Address - Country:US
Mailing Address - Phone:212-752-1919
Mailing Address - Fax:
Practice Address - Street 1:35 E 38TH ST APT 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2528
Practice Address - Country:US
Practice Address - Phone:212-776-4259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048051-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty