Provider Demographics
NPI:1992388193
Name:CITY HEIGHTS DENTAL PC
Entity Type:Organization
Organization Name:CITY HEIGHTS DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:122-568-1500
Mailing Address - Street 1:4401 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-4014
Mailing Address - Country:US
Mailing Address - Phone:212-568-1500
Mailing Address - Fax:
Practice Address - Street 1:4401 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-4014
Practice Address - Country:US
Practice Address - Phone:212-568-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental