Provider Demographics
NPI:1679651079
Name:WEBSTER DENTAL PLAZA, P.C.
Entity Type:Organization
Organization Name:WEBSTER DENTAL PLAZA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMADREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARRINNEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-262-0113
Mailing Address - Street 1:1231 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-3373
Mailing Address - Country:US
Mailing Address - Phone:646-402-8989
Mailing Address - Fax:646-402-8988
Practice Address - Street 1:1231 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3373
Practice Address - Country:US
Practice Address - Phone:646-402-8989
Practice Address - Fax:646-402-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60836122300000X, 1223G0001X, 1223P0106X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty