Individual
PETHAN TIN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1940 GRAND CONCOURSE, BRONX, NY 10457-5221
(718) 583-6347
(718) 583-8047
Mailing address
120 W 86TH ST, NEW YORK, NY 10024-4021
(917) 714-7593
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
052227
NY
Other
Enumeration date
05/26/2006
Last updated
07/08/2007
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