Provider Demographics
NPI:1215028428
Name:DENTAL ARTS AT LEXINGTON & 63RD ST PC
Entity type:Organization
Organization Name:DENTAL ARTS AT LEXINGTON & 63RD ST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARITO
Authorized Official - Middle Name:DELA CRUZ
Authorized Official - Last Name:MORADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-581-3030
Mailing Address - Street 1:105 E 63RD ST
Mailing Address - Street 2:SUITE 1A-1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-7329
Mailing Address - Country:US
Mailing Address - Phone:212-581-3030
Mailing Address - Fax:212-207-8521
Practice Address - Street 1:105 E 63RD ST
Practice Address - Street 2:SUITE 1A-1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-7329
Practice Address - Country:US
Practice Address - Phone:212-581-3030
Practice Address - Fax:212-207-8521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04327011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty