Provider Demographics
NPI:1578713087
Name:AESTHETIC CREATIONS DENTAL, P.L.L.C.
Entity Type:Organization
Organization Name:AESTHETIC CREATIONS DENTAL, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:KYUNG-SEOK
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-382-8443
Mailing Address - Street 1:159 E 30TH ST
Mailing Address - Street 2:#16A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-7300
Mailing Address - Country:US
Mailing Address - Phone:646-382-8443
Mailing Address - Fax:
Practice Address - Street 1:509 MADISON AVE
Practice Address - Street 2:SUITE 702
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5501
Practice Address - Country:US
Practice Address - Phone:212-688-0103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0527461223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty