Provider Demographics
NPI:1639648819
Name:EMERGENCY DENTIST NYC
Entity Type:Organization
Organization Name:EMERGENCY DENTIST NYC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:DATIKASHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-917-6886
Mailing Address - Street 1:100 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-5375
Mailing Address - Country:US
Mailing Address - Phone:212-600-4274
Mailing Address - Fax:
Practice Address - Street 1:100 E 12TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-5375
Practice Address - Country:US
Practice Address - Phone:212-600-4274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-17
Last Update Date:2018-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty