Provider Demographics
NPI:1801429840
Name:LES DENTAL GROUP PC
Entity type:Organization
Organization Name:LES DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GITLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-729-8506
Mailing Address - Street 1:62 RIVINGTON ST STE 1A-D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-2140
Mailing Address - Country:US
Mailing Address - Phone:212-979-0990
Mailing Address - Fax:
Practice Address - Street 1:62 RIVINGTON ST STE 1A-D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-2140
Practice Address - Country:US
Practice Address - Phone:212-979-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental