Organization
125TH ST. DENTAL GROUP, PLLC
Active
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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