Healthcare Provider Details

I. General information

NPI: 1295275220
Provider Name (Legal Business Name): GUN HILL DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E GUN HILL RD
BRONX NY
10467-2269
US

IV. Provider business mailing address

301 E GUN HILL RD
BRONX NY
10467-2269
US

V. Phone/Fax

Practice location:
  • Phone: 718-740-6000
  • Fax: 718-740-6004
Mailing address:
  • Phone: 718-740-6000
  • Fax: 718-740-6004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN KATAYEV
Title or Position: PRESIDENT
Credential:
Phone: 718-740-6000