Organization
DENTAL ANESTHESIA OF NEW YORK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHONG TA DDS (DENTIST ANESTHESIOLOGIST/OWNER)
(215) 527-8768
Entity
Organization
Contact information
Practice address
410 W 53RD ST APT 126, NEW YORK, NY 10019-5693
(215) 527-8768
Mailing address
410 W 53RD ST APT 126, NEW YORK, NY 10019-5693
(215) 527-8768
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
Primary
054360
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03203894
—
NY
Enumeration date
06/16/2016
Last updated
06/16/2016
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