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Organization
FOURTH AVENUE DENTAL
Active
Organization
FOURTH AVENUE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW MARON DMD (DENTIST)
(718) 439-2876
Entity
Organization
Contact information
Practice address
5404 4TH AVE, BROOKLYN, NY 11220-3006
(718) 439-2876
(718) 439-2879
Mailing address
5404 4TH AVE, BROOKLYN, NY 11220-3006
(718) 439-2876
(718) 439-2879
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
NULL
122300000X
Dentist
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
03/23/2011
Last updated
08/07/2012
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