Organization
FORDHAM ROAD DENTAL PC
Active
Other names
Executive Associates, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE BERTUZZI (PRACTICE MANAGER)
(845) 304-6110
Entity
Organization
Contact information
Practice address
327 E FORDHAM RD, 2ND FLOOR, BRONX, NY 10458-5002
(718) 933-8400
(718) 933-3731
Mailing address
327 E FORDHAM RD, 2ND FLOOR, BRONX, NY 10458-5002
(718) 933-8400
(718) 933-3731
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/10/2007
Last updated
05/26/2016
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