Basic Information
| Provider Information | |||||||||
| NPI: | 1437458270 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STARRETT CITY DENTAL GROUP ASSOCIATES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1390 PENNSYLVANIA AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112392103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186428600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1390 PENNSYLVANIA AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112392103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186428600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2011 | ||||||||
| LastUpdateDate: | 03/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | AMINOV | ||||||||
| AuthorizedOfficialFirstName: | STELLA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DENTIST | ||||||||
| AuthorizedOfficialTelephone: | 7188734550 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 054029 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.