Provider Demographics
NPI:1457525271
Name:SRP DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:SRP DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SURENDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-933-9603
Mailing Address - Street 1:250 W CLARKSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-7221
Mailing Address - Country:US
Mailing Address - Phone:718-933-9603
Mailing Address - Fax:718-866-0337
Practice Address - Street 1:48 E KINGSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-7514
Practice Address - Country:US
Practice Address - Phone:718-933-9603
Practice Address - Fax:718-866-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN0013148OtherFLORIDA LIC.
NY033320OtherNEW YORK LIC. #
CA52177OtherCALIFORNIA LIC.
NY00291350Medicaid