Provider Demographics
NPI:1578392775
Name:CANOPY DENTISTRY - DOWNTOWN BROOKLYN, PLLC
Entity type:Organization
Organization Name:CANOPY DENTISTRY - DOWNTOWN BROOKLYN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:OMOYENI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-842-0522
Mailing Address - Street 1:49 FLATBUSH AVE # 116
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 NEVINS ST UNIT 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-4852
Practice Address - Country:US
Practice Address - Phone:929-356-1140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty