Provider Demographics
NPI:1942452396
Name:TRIBECA DENTAL CLINIQUE
Entity Type:Organization
Organization Name:TRIBECA DENTAL CLINIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUJARAN-GHOMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-587-0000
Mailing Address - Street 1:123 CHAMBERS ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-1332
Mailing Address - Country:US
Mailing Address - Phone:212-587-0000
Mailing Address - Fax:212-587-0033
Practice Address - Street 1:123 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1332
Practice Address - Country:US
Practice Address - Phone:212-587-0000
Practice Address - Fax:212-587-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty