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Organization
PROFESSIONAL DENTAL SERVICE
Active
Organization
PROFESSIONAL DENTAL SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALBA R MARIA-DIAZ DDS (DENTIST)
(212) 738-0005
Entity
Organization
Contact information
Practice address
611 W 156TH ST, SUITE 55, NEW YORK, NY 10032-7508
(212) 738-0005
(212) 368-4391
Mailing address
611 W 156TH ST, SUITE 55, NEW YORK, NY 10032-7508
(212) 738-0005
(212) 368-4391
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
052157-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02694315
—
NY
01
—
9200203
DORAL
NY
Enumeration date
03/27/2008
Last updated
03/27/2008
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