Basic Information
| Provider Information | |||||||||
| NPI: | 1295937233 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MADISON DENTAL ARTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 MADISON AVE | ||||||||
| Address2: | SUITE 2500 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100161101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125321400 | ||||||||
| FaxNumber: | 2125324655 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 MADISON AVE | ||||||||
| Address2: | SUITE 2500 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100161101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125321400 | ||||||||
| FaxNumber: | 2125324655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 10/15/2007 | ||||||||
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| AuthorizedOfficialLastName: | GREENE | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | ALAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2125321400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.D.S. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 033275 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.