Provider Demographics
NPI:1205066412
Name:23RD STREET DENTAL LLC
Entity type:Organization
Organization Name:23RD STREET DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:NADOLNE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-206-7215
Mailing Address - Street 1:49 W 23RD ST
Mailing Address - Street 2:12TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4206
Mailing Address - Country:US
Mailing Address - Phone:212-206-7215
Mailing Address - Fax:212-206-1436
Practice Address - Street 1:49 W 23RD ST
Practice Address - Street 2:12TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4206
Practice Address - Country:US
Practice Address - Phone:212-206-7215
Practice Address - Fax:212-206-1436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0478831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty