Provider Demographics
NPI:1356420970
Name:BRONX DENTAL,P.C.
Entity type:Organization
Organization Name:BRONX DENTAL,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SYMECKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-292-3800
Mailing Address - Street 1:2604 3RD AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-1199
Mailing Address - Country:US
Mailing Address - Phone:718-292-3800
Mailing Address - Fax:718-292-3803
Practice Address - Street 1:2604 3RD AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-1199
Practice Address - Country:US
Practice Address - Phone:718-292-3800
Practice Address - Fax:718-292-3803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02661181Medicaid