Organization
EXECUTIVE DENTAL CARE PC
Active
Other names
James M Wallett DDS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES M WALLETT DDS (OWNER)
(718) 748-6847
Entity
Organization
Contact information
Practice address
8011 FIFTH AVENUE, 2ND FLOOR, BROOKLYN, NY 11209
(718) 748-6847
(718) 748-0329
Mailing address
PO BOX 90507, 8011 FIFTH AVENUE 2ND FLOOR, BROOKLYN, NY 11209
(718) 748-6847
(718) 748-0329
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
03663901
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00759435
—
NY
Enumeration date
09/13/2007
Last updated
09/13/2007
Update your record
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