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General NPI Number Information
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NPI Number | 1003338674
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Entity Type | Organization
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Legal Business Name | NEIGHBORHOOD DENTAL OF BUSHWICK PC
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Dates
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Enumeration Date | 07/14/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 291 KNICKERBOCKER AVE
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City | BROOKLYN
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State | NY
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Zip | 11237
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Country | US
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Telephone | 718-963-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 291 KNICKERBOCKER AVE
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City | BROOKLYN
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State | NY
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Zip | 11237-3103
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Country | US
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Telephone | 718-963-9500
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | MRS. OLGA MIHNYONOK
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Credential |
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Telephone | 718-963-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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