Organization
21ST CENTURYDENTAL COSMETIC HEALTH P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAHRYAR SEDGH (PRESIDENT)
(718) 384-2662
Entity
Organization
Contact information
Practice address
738 BROADWAY, 2ND FLOOR, BROOKLYN, NY 11206-4403
(718) 384-2662
(718) 384-6408
Mailing address
738 BROADWAY, BROOKLYN, NY 11206-4403
(718) 384-2662
(718) 384-6408
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
043066
NY
1223G0001X
General Practice Dentistry
046985
NY
1223G0001X
General Practice Dentistry
Primary
047141
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346470192
—
NY
05
—
1508919820
—
NY
05
—
1851506596
—
NY
Enumeration date
12/20/2011
Last updated
12/20/2011
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