Organization
125TH ST. DENTAL GROUP, PLLC
Active
Other names
125 St. Braces
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL KUNCIO DDS (MEMBER)
(646) 505-8852
Entity
Organization
Contact information
Practice address
63 W 125TH ST, 2ND FLOOR, NEW YORK, NY 10027-4512
(646) 505-8852
Mailing address
63 W 125TH ST, 2ND FLOOR, NEW YORK, NY 10027-4512
(646) 505-8852
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
051019
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01644504
—
NY
05
—
03047216
—
NY
05
—
03422386
—
NY
Enumeration date
07/19/2013
Last updated
07/19/2013
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