Organization
CONCOURSE WEST MANAGEMENT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHEL S KUPPER DDS (OWNER)
(718) 992-0410
Entity
Organization
Contact information
Practice address
880 RIVER AVE, BRONX, NY 10452-9431
(718) 992-0410
(718) 538-4323
Mailing address
880 RIVER AVE, BRONX, NY 10452-9431
(718) 992-0410
(718) 538-4323
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
050404
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01762532
—
NY
Enumeration date
10/26/2006
Last updated
08/22/2020
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