Healthcare Provider Details

I. General information

NPI: 1235344797
Provider Name (Legal Business Name): AK DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142-42A 41AVE
FLUSHING NY
11355
US

IV. Provider business mailing address

142-42A 41AVE
FLUSHING NY
11355
US

V. Phone/Fax

Practice location:
  • Phone: 718-445-5370
  • Fax: 718-445-5377
Mailing address:
  • Phone: 718-445-5370
  • Fax: 718-445-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number050248
License Number StateNY

VIII. Authorized Official

Name: DR. ARKADIY KHAITOV
Title or Position: DENTIST
Credential: DDS
Phone: 718-445-5370