Organization
174 STREET DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN SYCAMORE DDS (DENTIST)
(213) 709-7154
Entity
Organization
Contact information
Practice address
146 E 174TH ST, BRONX, NY 10457-6904
(213) 709-7154
Mailing address
146 E 174TH ST, BRONX, NY 10457-6904
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
053429
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02861549
—
NY
Enumeration date
07/08/2009
Last updated
07/08/2009
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