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Organization
WYCKOFF HEIGHTS DENTAL SERVICES P.C.
Active
Organization
WYCKOFF HEIGHTS DENTAL SERVICES P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VALI GACHE (CFO)
(718) 240-1795
Entity
Organization
Contact information
Practice address
374 STOCKHOLM ST, BROOKLYN, NY 11237-4006
(718) 963-7174
(718) 302-6744
Mailing address
374 STOCKHOLM ST, BROOKLYN, NY 11237-4006
(718) 963-7174
(718) 302-6744
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223D0004X
Dental Anesthesiology
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01894164
—
NY
Enumeration date
06/04/2006
Last updated
04/03/2019
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