Healthcare Provider Details

I. General information

NPI: 1912187600
Provider Name (Legal Business Name): CENTRAL PARK SOUTH DENTAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

200 CENTRAL PARK S SUITE 109
NEW YORK NY
10019-1436
US

IV. Provider business mailing address

200 CENTRAL PARK S SUITE 109
NEW YORK NY
10019-1436
US

V. Phone/Fax

Practice location:
  • Phone: 718-565-5445
  • Fax:
Mailing address:
  • Phone: 718-565-5445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number044129-1
License Number StateNY

VIII. Authorized Official

Name: DR. OLEG KLEMPNER
Title or Position: PRESIDENT
Credential: DDS
Phone: 718-565-5445