Provider Demographics
NPI:1982992780
Name:NN'S DENTAL GALLERY
Entity Type:Organization
Organization Name:NN'S DENTAL GALLERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATALI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-695-2173
Mailing Address - Street 1:450 7TH AVE
Mailing Address - Street 2:#800
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10123-0101
Mailing Address - Country:US
Mailing Address - Phone:212-695-2173
Mailing Address - Fax:212-695-1921
Practice Address - Street 1:450 7TH AVE
Practice Address - Street 2:#800
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10123-0101
Practice Address - Country:US
Practice Address - Phone:212-695-2173
Practice Address - Fax:212-695-1921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050360261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental