Provider Demographics
NPI:1699829994
Name:WASHINGTON SQUARE DENTAL GROUP , P.C.
Entity Type:Organization
Organization Name:WASHINGTON SQUARE DENTAL GROUP , P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER- PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOROWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-674-4011
Mailing Address - Street 1:2 5TH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8855
Mailing Address - Country:US
Mailing Address - Phone:212-674-4011
Mailing Address - Fax:
Practice Address - Street 1:2 5TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8855
Practice Address - Country:US
Practice Address - Phone:212-674-4011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty