Provider Demographics
NPI:1124459706
Name:ASTOR SMILE DENTAL PLLC
Entity type:Organization
Organization Name:ASTOR SMILE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EUNJUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:JO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-254-0800
Mailing Address - Street 1:191 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2501
Mailing Address - Country:US
Mailing Address - Phone:212-254-0800
Mailing Address - Fax:
Practice Address - Street 1:191 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2501
Practice Address - Country:US
Practice Address - Phone:212-254-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056719261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental