Provider Demographics
NPI:1396138053
Name:SOUTHWEST BROOKLYN DENTAL PRACTICE, PLLC
Entity type:Organization
Organization Name:SOUTHWEST BROOKLYN DENTAL PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLPIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-630-6866
Mailing Address - Street 1:150 55TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2508
Mailing Address - Country:US
Mailing Address - Phone:347-911-4485
Mailing Address - Fax:718-630-8714
Practice Address - Street 1:476 48TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-6844
Practice Address - Country:US
Practice Address - Phone:347-377-4485
Practice Address - Fax:718-630-8714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1076981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty