| N.y. Dental Professional | |
|
250 Mercer St., B908 Ny NY 10012 | |
| (917) 952-7813 | |
| Not Available |
| Full Name | N.y. Dental Professional |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 250 Mercer St., B908, Ny, New York |
| Authorized Official Name and Position | Jason Liem (PRESIDENT) |
| Authorized Official Contact | 9179527813 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| N.y. Dental Professional 250 Mercer St., B908 Ny NY 10012 Ph: (917) 952-7813 | N.y. Dental Professional 250 Mercer St., B908 Ny NY 10012 Ph: (917) 952-7813 |
| NPI Number | 1871793703 |
|---|---|
| Provider Enumeration Date | 07/19/2007 |
| Last Update Date | 07/19/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871793703 | NPI | - | NPPES |
| 02439247 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 049885 (New York) | Primary |
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