Provider Demographics
NPI:1689853459
Name:PARK SOUTH DENTAL P.L.L.C.
Entity Type:Organization
Organization Name:PARK SOUTH DENTAL P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STERLING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-892-2200
Mailing Address - Street 1:1530 UNIONPORT RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-7801
Mailing Address - Country:US
Mailing Address - Phone:718-892-2200
Mailing Address - Fax:718-892-5630
Practice Address - Street 1:1530 UNIONPORT RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-7801
Practice Address - Country:US
Practice Address - Phone:718-892-2200
Practice Address - Fax:718-892-5630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0380521223G0001X
NY0493591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty