Provider Demographics
NPI:1013326941
Name:EMMANUIL TEPER DENTAL,PC
Entity Type:Organization
Organization Name:EMMANUIL TEPER DENTAL,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:TEPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-643-7440
Mailing Address - Street 1:1310 AVENUE R
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2853
Mailing Address - Country:US
Mailing Address - Phone:718-676-1689
Mailing Address - Fax:718-676-1690
Practice Address - Street 1:1310 AVENUE R
Practice Address - Street 2:SUITE 1D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2853
Practice Address - Country:US
Practice Address - Phone:718-676-1689
Practice Address - Fax:718-676-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049489122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02189242Medicaid