Provider Demographics
NPI:1295273357
Name:DENTAL ARTIST, LLC
Entity type:Organization
Organization Name:DENTAL ARTIST, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CLIBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-614-2662
Mailing Address - Street 1:8 GRAMERCY PARK S
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1718
Mailing Address - Country:US
Mailing Address - Phone:212-614-2662
Mailing Address - Fax:
Practice Address - Street 1:8 GRAMERCY PARK S
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1718
Practice Address - Country:US
Practice Address - Phone:212-614-2662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053659122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty