Provider Demographics
NPI:1760155444
Name:EAST SIDE ESDA INC D/B/A EAST SIDE DENTAL ARTS
Entity Type:Organization
Organization Name:EAST SIDE ESDA INC D/B/A EAST SIDE DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MORDECAI MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:LIECHTUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-247-2330
Mailing Address - Street 1:225 E 70TH ST STE 1E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5213
Mailing Address - Country:US
Mailing Address - Phone:212-517-5940
Mailing Address - Fax:
Practice Address - Street 1:225 E 70TH ST STE 1E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5213
Practice Address - Country:US
Practice Address - Phone:212-517-5940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty