Provider Demographics
NPI:1316356520
Name:21ST CENTURY DENTAL OF CANARSIE
Entity type:Organization
Organization Name:21ST CENTURY DENTAL OF CANARSIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WANK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-241-1203
Mailing Address - Street 1:9715 AVENUE L
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4431
Mailing Address - Country:US
Mailing Address - Phone:718-241-1203
Mailing Address - Fax:212-220-0202
Practice Address - Street 1:9715 AVENUE L
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4431
Practice Address - Country:US
Practice Address - Phone:718-241-1203
Practice Address - Fax:212-220-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040328261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental