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Organization
N.Y. DENTAL PROFESSIONAL
Active
Organization
N.Y. DENTAL PROFESSIONAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON LIEM (PRESIDENT)
(917) 952-7813
Entity
Organization
Contact information
Practice address
250 MERCER ST., B908, NY, NY 10012
(917) 952-7813
Mailing address
250 MERCER ST., B908, NY, NY 10012
(917) 952-7813
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
049885
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02439247
—
NY
Enumeration date
07/19/2007
Last updated
07/19/2007
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