Provider Demographics
NPI:1790843035
Name:PELHAM PARKWAY DENTAL ASSOCIATES PC
Entity Type:Organization
Organization Name:PELHAM PARKWAY DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:TEICHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-823-8830
Mailing Address - Street 1:1088 MORRIS PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461
Mailing Address - Country:US
Mailing Address - Phone:718-823-8830
Mailing Address - Fax:718-792-8647
Practice Address - Street 1:1088 MORRIS PARK AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-823-8830
Practice Address - Fax:718-792-8647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty