Provider Demographics
NPI:1740451418
Name:CLINICA DENTAL ACUARO, P.C.
Entity type:Organization
Organization Name:CLINICA DENTAL ACUARO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-781-9535
Mailing Address - Street 1:336 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6803
Mailing Address - Country:US
Mailing Address - Phone:212-781-9535
Mailing Address - Fax:212-781-8600
Practice Address - Street 1:336 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6803
Practice Address - Country:US
Practice Address - Phone:212-781-9535
Practice Address - Fax:212-781-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047127-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01759200Medicaid