Provider Demographics
NPI:1902079080
Name:TRIBECA DENTAL
Entity Type:Organization
Organization Name:TRIBECA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DORFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-431-4582
Mailing Address - Street 1:402 BROADWAY
Mailing Address - Street 2:LL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3519
Mailing Address - Country:US
Mailing Address - Phone:212-431-4582
Mailing Address - Fax:212-431-4939
Practice Address - Street 1:402 BROADWAY
Practice Address - Street 2:LL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3519
Practice Address - Country:US
Practice Address - Phone:212-431-4582
Practice Address - Fax:212-431-4939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051670-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty