Provider Demographics
NPI:1588133557
Name:LIFE BRIDGE DENTAL PLLC
Entity type:Organization
Organization Name:LIFE BRIDGE DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:NARAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARYANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-651-4364
Mailing Address - Street 1:5505 N CUMBERLAND AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-4761
Mailing Address - Country:US
Mailing Address - Phone:212-651-4364
Mailing Address - Fax:615-468-0325
Practice Address - Street 1:29 E 21ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6209
Practice Address - Country:US
Practice Address - Phone:212-686-3686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty