Provider Demographics
NPI:1053525998
Name:BRIARCLIFF MANOR DENTAL SERVICE PC
Entity type:Organization
Organization Name:BRIARCLIFF MANOR DENTAL SERVICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TEITELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:914-941-4890
Mailing Address - Street 1:1312 PLEASANTVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1601
Mailing Address - Country:US
Mailing Address - Phone:914-941-4890
Mailing Address - Fax:914-941-7770
Practice Address - Street 1:1312 PLEASANTVILLE RD
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1601
Practice Address - Country:US
Practice Address - Phone:914-941-4890
Practice Address - Fax:914-941-7770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0429821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty