Provider Demographics
NPI: | 1689823791 |
---|---|
Name: | DIAMOND DENTAL, P.C. |
Entity Type: | Organization |
Organization Name: | DIAMOND DENTAL, P.C. |
Other - Org Name: | DIAMOND DENTAL MANHATTAN |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KUANGHAN |
Authorized Official - Middle Name: | GEORGE |
Authorized Official - Last Name: | LEE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 212-682-1488 |
Mailing Address - Street 1: | 161 MADISON AVE RM 7NW |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW YORK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10016-5449 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 212-682-1488 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 420 LEXINGTON AVE RM 228 |
Practice Address - Street 2: | |
Practice Address - City: | NEW YORK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10170-0299 |
Practice Address - Country: | US |
Practice Address - Phone: | 212-682-1488 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-09-12 |
Last Update Date: | 2022-11-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 48213 | 122300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Multi-Specialty |