Healthcare Provider Details

I. General information

NPI: 1336068154
Provider Name (Legal Business Name): KIDS DENTAL OF UNION CITY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4003 BERGENLINE AVE
UNION CITY NJ
07087-5277
US

IV. Provider business mailing address

4003 BERGENLINE AVE
UNION CITY NJ
07087-5277
US

V. Phone/Fax

Practice location:
  • Phone: 347-512-4887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DMITRIY VOLOTSENKO
Title or Position: PRESIDENT
Credential: DDS
Phone: 917-797-8052