174 Street Dental LLC

NPI #1134358427 in Bronx, New York

Provider Information

NPI Number: 1134358427
Entity Type: Organization
Organization Name: 174 Street Dental LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Jul 8, 2009
Last Updated: Jul 8, 2009

Practice Location

Address: 146 E 174TH ST
City: Bronx
State: New York
ZIP Code: 10457-6904
Phone: (213) 709-7154

Authorized Official

Name: DR. JUSTIN SYCAMORE, DDS
Title: DENTIST
Phone: (213) 709-7154

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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