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General NPI Number Information
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NPI Number | 1164575478
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Entity Type | Organization
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Legal Business Name | AVENUE U ORTHODONTICS, PLLC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 79 AVENUE U
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City | BROOKLYN
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State | NY
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Zip | 11223-3554
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Country | US
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Telephone | 718-373-6707
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Fax | 888-292-7017
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Provider Business Mailing Address
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Address Line | 15 ENGLE STREET SUITE 204
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-2936
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Country | US
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Telephone | 201-308-8181
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Fax | 888-292-7017
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Authorized Official
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Title or Position | OWNER
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Name | DR. OLEG DRUT
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Credential | DDS
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Telephone | 201-308-8181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DI20707
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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