Provider Demographics
NPI:1013235068
Name:AARON'S DENTAL CARE
Entity Type:Organization
Organization Name:AARON'S DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-234-6088
Mailing Address - Street 1:2474 8TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-7710
Mailing Address - Country:US
Mailing Address - Phone:212-234-6088
Mailing Address - Fax:212-234-6088
Practice Address - Street 1:2474 8TH AVE STE A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-7710
Practice Address - Country:US
Practice Address - Phone:212-234-6088
Practice Address - Fax:212-234-6088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0508041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1790978971Medicaid