Organization
GLAD DENTAL P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LIA DATIKASHVILI D.D.S. (PRESIDENT)
(646) 404-5005
Entity
Organization
Contact information
Practice address
293 E 149TH ST, BRONX, NY 10451-5601
(646) 404-5005
(646) 404-5006
Mailing address
293 E 149TH ST, BRONX, NY 10451-5601
(646) 404-5005
(646) 404-5006
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
055422-1
NY
Other
Enumeration date
07/20/2011
Last updated
07/20/2011
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