Provider Demographics
NPI:1841486669
Name:AMERICAN DENTAL ARTS
Entity type:Organization
Organization Name:AMERICAN DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:POLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-929-9200
Mailing Address - Street 1:281 CORBIN PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4901
Mailing Address - Country:US
Mailing Address - Phone:212-929-9200
Mailing Address - Fax:
Practice Address - Street 1:420 W 23RD ST # 1F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2172
Practice Address - Country:US
Practice Address - Phone:212-929-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-16
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0453491122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01485125Medicaid