Provider Demographics
NPI:1811034804
Name:MTN TRIBECA DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:MTN TRIBECA DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONG TRINH
Authorized Official - Middle Name:THI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-925-4000
Mailing Address - Street 1:249 W BROADWAY STE 2D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-2463
Mailing Address - Country:US
Mailing Address - Phone:212-925-4000
Mailing Address - Fax:212-925-4000
Practice Address - Street 1:249 W BROADWAY STE 2D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-2463
Practice Address - Country:US
Practice Address - Phone:212-925-4000
Practice Address - Fax:212-925-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043629122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01282439Medicaid