Provider Demographics
NPI:1407946353
Name:GREEN DENTISTRY, P.C.
Entity type:Organization
Organization Name:GREEN DENTISTRY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:212-799-7700
Mailing Address - Street 1:211 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6224
Mailing Address - Country:US
Mailing Address - Phone:212-799-7700
Mailing Address - Fax:212-874-5915
Practice Address - Street 1:211 W 79TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6224
Practice Address - Country:US
Practice Address - Phone:212-799-7700
Practice Address - Fax:212-874-5915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0203031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty