Organization
BRONX RIVER DENTAL P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EZRO FATTAKHOV DDS (DOCTOR/OWNER)
(718) 456-2626
Entity
Organization
Contact information
Practice address
3000 BRONX PARK E, BRONX, NY 10467-6711
(718) 655-0075
(718) 708-6966
Mailing address
3000 BRONX PARK E, BRONX, NY 10467-6711
(718) 655-0075
(718) 708-6966
Taxonomy
Speciality
Code
Description
License number
State
125J00000X
Dental Therapist
Primary
046846
NY
Other
Enumeration date
01/29/2013
Last updated
11/14/2013
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