1700939527 NPI number — LIANA VIORICA DUMITRU GENERAL DENTIST

Table of content: LIANA VIORICA DUMITRU GENERAL DENTIST (NPI 1700939527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700939527 NPI number — LIANA VIORICA DUMITRU GENERAL DENTIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUMITRU
Provider First Name:
LIANA
Provider Middle Name:
VIORICA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
GENERAL DENTIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700939527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 863042
Provider Second Line Business Mailing Address:
5825 MYRTLE AVENUE
Provider Business Mailing Address City Name:
RIDGEWOOD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-821-1961
Provider Business Mailing Address Fax Number:
718-821-6491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5825 MYRTLE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGEWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-821-1961
Provider Business Practice Location Address Fax Number:
718-821-6491
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  0452161 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01823303 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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