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Organization

FOURTH AVENUE DENTAL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ANDREW MARON DMD (DENTIST)
(718) 439-2876
Entity
Organization

Contact information

Practice address
5404 4TH AVE, BROOKLYN, NY 11220-3006
(718) 439-2876
(718) 439-2879
Mailing address
5404 4TH AVE, BROOKLYN, NY 11220-3006
(718) 439-2876
(718) 439-2879

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
03170656
NY
Enumeration date
03/23/2011
Last updated
08/07/2012
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