Provider Demographics
NPI:1669753299
Name:MANDALAY DENTAL CARE PC
Entity type:Organization
Organization Name:MANDALAY DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHOEBE
Authorized Official - Middle Name:TIN TIN
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-227-4349
Mailing Address - Street 1:98 E BROADWAY STE 501
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-7181
Mailing Address - Country:US
Mailing Address - Phone:212-227-4349
Mailing Address - Fax:212-226-1613
Practice Address - Street 1:98 E BROADWAY STE 501
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7181
Practice Address - Country:US
Practice Address - Phone:212-227-4349
Practice Address - Fax:212-226-1613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0477921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty