Provider Demographics
NPI:1730657495
Name:OLD GREENWHICH DENTAL CENTER LLC
Entity Type:Organization
Organization Name:OLD GREENWHICH DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JANASH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-915-4504
Mailing Address - Street 1:230 W 41ST ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-7207
Mailing Address - Country:US
Mailing Address - Phone:917-915-4504
Mailing Address - Fax:866-897-8738
Practice Address - Street 1:182 SOUND BEACH AVE
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1738
Practice Address - Country:US
Practice Address - Phone:917-915-4504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-10
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty