Provider Demographics
NPI:1740804541
Name:CITIBRITES DENTAL BAYCHESTER LLC
Entity Type:Organization
Organization Name:CITIBRITES DENTAL BAYCHESTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-850-3543
Mailing Address - Street 1:4000 BAYCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2314
Mailing Address - Country:US
Mailing Address - Phone:646-828-2566
Mailing Address - Fax:
Practice Address - Street 1:4000 BAYCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2314
Practice Address - Country:US
Practice Address - Phone:646-828-2566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty