Organization
URBAN PEDIATRIC DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JESSICA LOO MARN D.D.S (PRACTICE OWNER)
(212) 965-8113
Entity
Organization
Contact information
Practice address
128 MOTT STREET, SUITE 203, NEW YORK, NY 10013-5575
(212) 965-8113
Mailing address
128 MOTT STREET, SUITE 203, NEW YORK, NY 10013-5575
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
0497501
NY
302R00000X
Health Maintenance Organization
0535941
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02902734
—
NY
Enumeration date
11/16/2010
Last updated
01/24/2013
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