Provider Demographics
NPI:1427047406
Name:MA, PHOEBE TIN TIN (DMD)
Entity type:Individual
Prefix:DR
First Name:PHOEBE
Middle Name:TIN TIN
Last Name:MA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:TIN
Other - Middle Name:
Other - Last Name:MA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:98 E. BROADWAY
Mailing Address - Street 2:SUITE 501
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-7181
Mailing Address - Country:US
Mailing Address - Phone:212-227-4349
Mailing Address - Fax:212-227-3216
Practice Address - Street 1:98 E. BROADWAY
Practice Address - Street 2:SUITE 501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7181
Practice Address - Country:US
Practice Address - Phone:212-227-4349
Practice Address - Fax:212-227-3216
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047792122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01892277Medicaid