Provider Demographics
NPI:1417027756
Name:COMMUNITY DENTAL ASSOCIATES PC
Entity type:Organization
Organization Name:COMMUNITY DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS FAAHD
Authorized Official - Phone:212-755-1637
Mailing Address - Street 1:133 E 54TH ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4538
Mailing Address - Country:US
Mailing Address - Phone:212-755-1637
Mailing Address - Fax:212-371-0557
Practice Address - Street 1:133 E 54TH ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4538
Practice Address - Country:US
Practice Address - Phone:212-755-1637
Practice Address - Fax:212-371-0557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026694122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAW3152410OtherUNITED CONCORDIA