Healthcare Provider Details

I. General information

NPI: 1699339069
Provider Name (Legal Business Name): KAMENSHCHIK ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 COLD SPRING RD STE 101
SYOSSET NY
11791-3140
US

IV. Provider business mailing address

111 CONKLIN ST FL 2
FARMINGDALE NY
11735-2505
US

V. Phone/Fax

Practice location:
  • Phone: 516-253-1016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. AVA KAMENSHCHIK
Title or Position: OWNER/DOCTOR
Credential: DDS
Phone: 516-297-8628