Organization
GEORGETOWNDENTALSPA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW MARON DDS (PRESIDENT)
(718) 676-7700
Entity
Organization
Contact information
Practice address
2167 RALPH AVE, BROOKLYN, NY 11234
(718) 676-7700
Mailing address
2167 RALPH AVE, BROOKLYN, NY 11234-5405
(718) 676-7700
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
043641
NY
Other
Enumeration date
02/05/2014
Last updated
02/05/2014
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