Provider Demographics
NPI:1821260712
Name:BRONX DENTAL CENTER INC
Entity Type:Organization
Organization Name:BRONX DENTAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:MIREYA
Authorized Official - Last Name:RIJOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-563-0303
Mailing Address - Street 1:2420 DAVIDSON AVE
Mailing Address - Street 2:1 FL
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-6318
Mailing Address - Country:US
Mailing Address - Phone:718-563-0303
Mailing Address - Fax:718-367-7117
Practice Address - Street 1:2420 DAVIDSON AVE
Practice Address - Street 2:1 FL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-6318
Practice Address - Country:US
Practice Address - Phone:718-563-0303
Practice Address - Fax:718-367-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0456701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01526392Medicaid