Organization
MANHATTAN BOULEVARD DENTAL ASSOCIATES, A PROFESSIONAL CORPORATION
Active
Other names
Today's Dental Cosmetic and Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DIMETRY COSSICH DDS (PRESIDENT)
(504) 361-5333
Entity
Organization
Contact information
Practice address
1090 NORTHCHASE PKWY SE, STE 150, MARIETTA, GA 30067-6405
(770) 916-5031
Mailing address
1708 MANHATTAN BLVD, SUITE C, HARVEY, LA 70058-3400
(504) 361-5333
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
09/24/2015
Last updated
09/24/2015
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