MEDICARE: YES DENTAL OF NY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	052869	NY
2	122300000X	Dentist	047879	NY

General Provider Information

NPI Number	:	1629336664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YES DENTAL OF NY, PLLC

Provider Business Mailing Address
First Line	:	1420 ST. NICHOLAS AVE, 2 FL
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-4050
Country	:	US
Telephone Number	:	212-781-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 ST. NICHOLAS AVE, 2 FL
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-4050
Country	:	US
Telephone Number	:	212-781-0700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DMITRIY VOLOTSENKO
Credential	:	DDS
Telephone Number	:	212-781-0700

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	04/27/2012

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