Provider Demographics
NPI:1912123555
Name:NYU COLLEGE OF DENTISTRY
Entity Type:Organization
Organization Name:NYU COLLEGE OF DENTISTRY
Other - Org Name:NYUFP OMFS
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSOC DEAN CLINICAL AFFAIRS
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:V
Authorized Official - Last Name:PANNO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-998-9505
Mailing Address - Street 1:421 1ST AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4001
Mailing Address - Country:US
Mailing Address - Phone:212-998-9439
Mailing Address - Fax:212-995-4843
Practice Address - Street 1:421 1ST AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4001
Practice Address - Country:US
Practice Address - Phone:212-998-9439
Practice Address - Fax:212-995-4843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021314-2261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery