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Organization
PROFESSIONAL DENTAL OFFICE PC
Active
Organization
PROFESSIONAL DENTAL OFFICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSA I DIAZ DDS (OWNER)
(718) 602-5200
Entity
Organization
Contact information
Practice address
167 RIVINGTON ST, NEW YORK, NY 10002
(212) 673-9367
(212) 673-9367
Mailing address
1323 MYRTLE AVE, BROOKLYN, NY 11221
(718) 602-5200
(718) 602-5200
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0484311
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01979033
—
NY
Enumeration date
03/14/2006
Last updated
08/22/2020
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