Provider Demographics
NPI:1487131009
Name:SOUTH END DENTAL PC
Entity type:Organization
Organization Name:SOUTH END DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-786-0930
Mailing Address - Street 1:375 S END AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1014
Mailing Address - Country:US
Mailing Address - Phone:212-786-0930
Mailing Address - Fax:212-656-1430
Practice Address - Street 1:375 S END AVE STE 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10280-1014
Practice Address - Country:US
Practice Address - Phone:212-786-0930
Practice Address - Fax:212-656-1430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1223X0400X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty