Provider Demographics
NPI:1710576202
Name:COLON LIZ DENTAL OFFICE PC
Entity Type:Organization
Organization Name:COLON LIZ DENTAL OFFICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DELFINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-519-6371
Mailing Address - Street 1:3467 DEKALB AVE APT 1G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2322
Mailing Address - Country:US
Mailing Address - Phone:718-994-0005
Mailing Address - Fax:718-994-6160
Practice Address - Street 1:3467 DEKALB AVE APT 1G
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2322
Practice Address - Country:US
Practice Address - Phone:718-994-0005
Practice Address - Fax:718-994-6160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental