Organization
CONCOURSE PLAZA FAMILY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GODRICK ALLISTER TAYLOR DDS (OWNER)
(347) 204-3362
Entity
Organization
Contact information
Practice address
230 E 161ST ST, BRONX, NY 10451-3546
(718) 992-8200
(718) 537-4169
Mailing address
230 E 161ST ST, BRONX, NY 10451-3546
(718) 992-8200
(718) 537-4169
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
052071
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02677278
—
NY
Enumeration date
09/09/2015
Last updated
09/09/2015
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