Healthcare Provider Details

I. General information

NPI: 1578898177
Provider Name (Legal Business Name): ARDEN DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 HAMPTON GREEN
STATEN ISLAND NY
10312-0000
US

IV. Provider business mailing address

337 HAMPTON GREEN
STATEN ISLAND NY
10312-0000
US

V. Phone/Fax

Practice location:
  • Phone: 718-948-0870
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: VALERY DUBOVIKOV
Title or Position: DDS/OWNER
Credential: DDS
Phone: 718-948-0870