Provider Demographics
NPI:1184791238
Name:METROPOLITAN DENTAL GROUP, P.C.
Entity type:Organization
Organization Name:METROPOLITAN DENTAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:PRABHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-969-0015
Mailing Address - Street 1:909 MIDLAND AVE
Mailing Address - Street 2:STE. C
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1092
Mailing Address - Country:US
Mailing Address - Phone:914-969-0015
Mailing Address - Fax:914-709-9346
Practice Address - Street 1:909 MIDLAND AVE
Practice Address - Street 2:STE. C
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1092
Practice Address - Country:US
Practice Address - Phone:914-969-0015
Practice Address - Fax:914-709-9346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044502122300000X
NY0435581223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty