Provider Demographics
NPI:1366586653
Name:BROOKLYN DENTAL HEALTH,P.C.
Entity type:Organization
Organization Name:BROOKLYN DENTAL HEALTH,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWALB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-624-6363
Mailing Address - Street 1:662 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-8017
Mailing Address - Country:US
Mailing Address - Phone:718-624-6363
Mailing Address - Fax:718-875-7446
Practice Address - Street 1:662 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-8017
Practice Address - Country:US
Practice Address - Phone:718-624-6363
Practice Address - Fax:718-875-7446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0038195122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02241610Medicaid