Healthcare Provider Details

I. General information

NPI: 1922679331
Provider Name (Legal Business Name): GMG DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 WILLIS AVE
ALBERTSON NY
11507-1333
US

IV. Provider business mailing address

1009 WILLIS AVE
ALBERTSON NY
11507-1333
US

V. Phone/Fax

Practice location:
  • Phone: 516-579-8950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. DMITRY MALAYEV
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 516-579-8950