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Organization
SOUL DENTAL WEST PLLC
Active
Organization
SOUL DENTAL WEST PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLA MALANITCHEVA (ADMINISTRATOR)
(718) 916-6748
Entity
Organization
Contact information
Practice address
853 11TH AVE, NEW YORK, NY 10019
(212) 201-0718
(646) 597-6068
Mailing address
853 11TH AVE, NEW YORK, NY 10019
(212) 201-0718
(646) 597-6068
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
055567
DENTAL LICENSE
NY
Enumeration date
02/14/2019
Last updated
02/14/2019
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