Provider Demographics
NPI:1740604131
Name:GREENWICH VILLAGE DENTAL ARTS PC
Entity Type:Organization
Organization Name:GREENWICH VILLAGE DENTAL ARTS PC
Other - Org Name:ADVANCED DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BERTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-388-1170
Mailing Address - Street 1:55 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6311
Mailing Address - Country:US
Mailing Address - Phone:212-388-1170
Mailing Address - Fax:212-388-1181
Practice Address - Street 1:55 EAST 9TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-388-1170
Practice Address - Fax:212-388-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048272122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY048272OtherDENTIST