Provider Demographics
NPI:1588988307
Name:PLEASANT DENTISTRY P.C.
Entity type:Organization
Organization Name:PLEASANT DENTISTRY P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-797-3935
Mailing Address - Street 1:81 WILLOUGHBY ST STE 202
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5291
Mailing Address - Country:US
Mailing Address - Phone:718-797-3935
Mailing Address - Fax:718-797-3967
Practice Address - Street 1:81 WILLOUGHBY ST STE 202
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5291
Practice Address - Country:US
Practice Address - Phone:718-797-3935
Practice Address - Fax:718-797-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0545051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03142490Medicaid