Basic Information
| Provider Information | |||||||||
| NPI: | 1588983738 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LALABA DENTAL PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 WOODLAND CT | ||||||||
| Address2: | |||||||||
| City: | ROSLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115761432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163653701 | ||||||||
| FaxNumber: | 5163653701 | ||||||||
| Practice Location | |||||||||
| Address1: | 679 E 138TH ST | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104543307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186656065 | ||||||||
| FaxNumber: | 7186656065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2010 | ||||||||
| LastUpdateDate: | 05/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | MITA | ||||||||
| AuthorizedOfficialMiddleName: | SHARAD | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5163653701 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.D.S | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
No ID Information.