Provider Demographics
NPI:1629380092
Name:AESTHETIC DENTAL GROUP OF BROOKLYN
Entity Type:Organization
Organization Name:AESTHETIC DENTAL GROUP OF BROOKLYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-853-2244
Mailing Address - Street 1:1528 49TH ST
Mailing Address - Street 2:SUITE 1B/1C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3254
Mailing Address - Country:US
Mailing Address - Phone:718-853-2244
Mailing Address - Fax:
Practice Address - Street 1:1528 49TH ST
Practice Address - Street 2:SUITE 1B/1C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3254
Practice Address - Country:US
Practice Address - Phone:718-853-2244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL B. SCHWARTZ DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039436122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty