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Organization
EXECUTIVE DENTAL CARE PC
Active
Organization
EXECUTIVE DENTAL CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES M WALLETT D.D.S. (GENERAL DENTIST/OWNER)
(718) 748-6847
Entity
Organization
Contact information
Practice address
8011 FIFTH AVENUE, 2ND FLOOR, BROOKLYN, NY 11209
(718) 748-6847
Mailing address
8011 FIFTH AVENUE, 2ND FLOOR, BROOKLYN, NY 11209
(718) 748-6847
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
036639
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00759435
—
NY
Enumeration date
04/24/2008
Last updated
04/24/2008
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