# GEORGETOWNDENTALSPA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194149674
- **Authorized official:** DR. ANDREW MARON DDS (PRESIDENT)
- **Authorized official phone:** (718) 676-7700

## Contact information

- **Practice address:** 2167 RALPH AVE, BROOKLYN, NY 11234
- **Practice address phone:** (718) 676-7700
- **Mailing address:** 2167 RALPH AVE, BROOKLYN, NY 11234-5405
- **Mailing address phone:** (718) 676-7700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 043641 | NY | Yes |

## Other

- **Enumeration date:** 02/05/2014
- **Last updated:** 02/05/2014