Provider Demographics
NPI:1689920860
Name:M&G DENTAL CENTER
Entity Type:Organization
Organization Name:M&G DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-832-1194
Mailing Address - Street 1:759 - 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232
Mailing Address - Country:US
Mailing Address - Phone:718-832-1194
Mailing Address - Fax:718-369-6831
Practice Address - Street 1:759 - 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232
Practice Address - Country:US
Practice Address - Phone:718-832-1194
Practice Address - Fax:718-369-6831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045832122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty