Provider Demographics
NPI:1699050443
Name:NYC DENTAL WELLNESS PLLC
Entity type:Organization
Organization Name:NYC DENTAL WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MADALINA
Authorized Official - Middle Name:MARINA
Authorized Official - Last Name:MANEA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-648-1287
Mailing Address - Street 1:200 CENTRAL PARK S
Mailing Address - Street 2:SUITE 109
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1449
Mailing Address - Country:US
Mailing Address - Phone:212-750-3988
Mailing Address - Fax:212-750-7102
Practice Address - Street 1:200 CENTRAL PARK S
Practice Address - Street 2:SUITE 109
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1449
Practice Address - Country:US
Practice Address - Phone:212-750-3988
Practice Address - Fax:212-750-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY0510001223G0001X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty