Provider Demographics
NPI:1922556414
Name:PROBITY DENTAL PLLC
Entity Type:Organization
Organization Name:PROBITY DENTAL PLLC
Other - Org Name:COVENANT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-842-0522
Mailing Address - Street 1:815 HUTCHINSON PKWY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1887
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:815 HUTCHINSON RIVER PKWY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1887
Practice Address - Country:US
Practice Address - Phone:646-578-8378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12656746261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty