573 Fordham Dental PC
Organization Active NPI General Practice Dentistry · Bronx, NY
NPI 1043634660 · NPPES record last updated Feb 18, 2014
Key facts
- NPI
- 1043634660
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Legal business name
- 573 FORDHAM DENTAL PC
- Practice address
- 573 E Fordham Rd
Bronx, NY 10458-5018 - Phone
- (917) 962-9990
- NPI assigned
- Feb 18, 2014
- Organization subpart
- No
Authorized official
- Name
- Nina Otano
- Title
- Office Manager
- Phone
- (917) 962-9990
Practitioners 1
-
Shan M Khan, DMD
National Provider Directory
Locations
573 E Fordham Rd
Bronx, NY 10458
Phone (917) 496-6032
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | Yes |
Addresses
Primary practice location
573 E Fordham Rd
Bronx, NY 10458-5018
Mailing address
573 E Fordham Rd
Bronx, NY 10458-5018
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.