Provider Demographics
NPI:1639676455
Name:WARREN STREET DENTAL PLLC
Entity type:Organization
Organization Name:WARREN STREET DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:J
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-921-1734
Mailing Address - Street 1:250 N 10TH ST APT 323
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2821
Mailing Address - Country:US
Mailing Address - Phone:516-987-6126
Mailing Address - Fax:
Practice Address - Street 1:293 COURT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-4407
Practice Address - Country:US
Practice Address - Phone:347-921-1734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental