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Organization
YOUR BRONX DENTIST
Active
Organization
YOUR BRONX DENTIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBBIE BOUTEHSAZ DDS (PRESIDENT)
(516) 455-6802
Entity
Organization
Contact information
Practice address
3310 BAINBRIDGE AVE, BRONX, NY 10467-2856
(718) 654-3456
Mailing address
3310 BAINBRIDGE AVE, BRONX, NY 10467-2856
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/12/2018
Last updated
09/12/2018
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