Healthcare Provider Details

I. General information

NPI: 1992841449
Provider Name (Legal Business Name): 42ND STREET DENTAL, ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W 42ND ST
NEW YORK NY
10036-6902
US

IV. Provider business mailing address

330 W 42ND ST
NEW YORK NY
10036-6902
US

V. Phone/Fax

Practice location:
  • Phone: 212-631-0222
  • Fax: 212-631-0114
Mailing address:
  • Phone: 212-631-0222
  • Fax: 212-631-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number046043
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number050148
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number046686
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number042707
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number050706
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number052674
License Number StateNY

VIII. Authorized Official

Name: DR. ROSS KRASNOV
Title or Position: ADMINISTRATOR
Credential: DDS
Phone: 212-631-0222