Healthcare Provider Details

I. General information

NPI: 1780053108
Provider Name (Legal Business Name): SBK DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 4TH AVE UNIT 2
BROOKLYN NY
11215-3201
US

IV. Provider business mailing address

385 4TH AVE UNIT 2
BROOKLYN NY
11215-3201
US

V. Phone/Fax

Practice location:
  • Phone: 347-708-9777
  • Fax: 347-708-9774
Mailing address:
  • Phone: 347-708-9777
  • Fax: 347-708-9774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number054655-1
License Number StateNY

VIII. Authorized Official

Name: DR. ANKUSH KHANNA
Title or Position: ORTHODONTIST/OWNER
Credential: DMD
Phone: 347-708-9777