Provider Demographics
NPI:1760905954
Name:MANHATTAN DENTAL STUDIO
Entity Type:Organization
Organization Name:MANHATTAN DENTAL STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-685-2476
Mailing Address - Street 1:358 5TH AVE RM 1005
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2209
Mailing Address - Country:US
Mailing Address - Phone:212-685-2476
Mailing Address - Fax:212-947-2826
Practice Address - Street 1:358 FIFTH AVE
Practice Address - Street 2:SUITE 1005
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:212-685-2476
Practice Address - Fax:212-947-2826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty