Provider Demographics
NPI:1841738960
Name:NYU DENTAL FACULTY PRACTICE
Entity Type:Organization
Organization Name:NYU DENTAL FACULTY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:COSMO
Authorized Official - Middle Name:V
Authorized Official - Last Name:DE STENO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PHD
Authorized Official - Phone:212-998-9926
Mailing Address - Street 1:726 BROADWAY
Mailing Address - Street 2:SUITE #350
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-9502
Mailing Address - Country:US
Mailing Address - Phone:212-443-1300
Mailing Address - Fax:212-443-1331
Practice Address - Street 1:726 BROADWAY
Practice Address - Street 2:SUITE #350
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-9502
Practice Address - Country:US
Practice Address - Phone:212-443-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000075-11223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty