Executive Dental Care Pc

LBN: Executive Dental Care Pc
Executive Dental Care Pc is an health care organization with primary practice located at 8011 Fifth Avenue 2Nd Floor, Brooklyn NY 11209. The organization recently has only one registered license in Managed Care Organizations / Preferred Provider Organization, which is considered as the primary health care specialty. Executive Dental Care Pc can be contacted via phone (718) 748-6847, or through Wallett, James M via phone (718) 748-6847.

Contact Information

Primary practice address
8011 Fifth Avenue 2Nd Floor Brooklyn NY 11209
Phone: (718) 748-6847
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Wallett, James M Doctor of Dental Surgery (DDS)
Phone: (718) 748-6847

Health care specialties

SpecialtyCodeLicense #State
Managed Care Organizations / Preferred Provider Organization 305R00000X 036639 New York

Profile Details

NPI number 1073788717
LBN Legal business name Executive Dental Care Pc
DBA Doing business as
Authorized official Wallett, James M Doctor of Dental Surgery (DDS)
Entity Organization
Organization subpart 1 No
Enumeration date Apr 24th, 2008
Last updated Apr 24th, 2008 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073788717 NPPES
New York MEDICAID 00759435

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