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Organization
PARK AVENUE DENTAL BOUTIQUE, L.L.C.
Active
Organization
PARK AVENUE DENTAL BOUTIQUE, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL WARSZAWSKI (SECRETARY)
(646) 455-8657
Entity
Organization
Contact information
Practice address
104 E 74TH ST, NEW YORK, NY 10021-3544
(212) 369-2202
Mailing address
104 E 74TH ST, NEW YORK, NY 10021-3544
(212) 369-2202
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0506391
NY
Other
Enumeration date
03/16/2018
Last updated
03/16/2018
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