Provider Demographics
NPI:1255052569
Name:TONGUE-TIE DENTAL OF NY PLLC
Entity type:Organization
Organization Name:TONGUE-TIE DENTAL OF NY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-841-7780
Mailing Address - Street 1:7 DARCY LN
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-1409
Mailing Address - Country:US
Mailing Address - Phone:917-841-7780
Mailing Address - Fax:203-286-1203
Practice Address - Street 1:774 WHITE PLAINS RD # 205
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5030
Practice Address - Country:US
Practice Address - Phone:204-724-7744
Practice Address - Fax:203-286-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty