Healthcare Provider Details

I. General information

NPI: 1093941361
Provider Name (Legal Business Name): VATRENKO GITLIN DENTAL OFFICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 BRIGHTON 11TH ST
BROOKLYN NY
11235-5327
US

IV. Provider business mailing address

178 BRIGHTON 11TH ST
BROOKLYN NY
11235-5327
US

V. Phone/Fax

Practice location:
  • Phone: 718-769-4116
  • Fax:
Mailing address:
  • Phone: 718-769-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number041069
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number045231
License Number StateNY

VIII. Authorized Official

Name: MR. MICHAEL GITLIN
Title or Position: VP
Credential: DDS
Phone: 718-769-4116