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General NPI Number Information
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NPI Number | 1194862953
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Entity Type | Organization
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Legal Business Name | ELDRIDGE DENTAL CARE P.C.
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1432 FOREST AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10302-2204
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Country | US
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Telephone | 718-442-9254
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Fax | 718-720-9107
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Provider Business Mailing Address
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Address Line | 1432 FOREST AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10302-2204
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Country | US
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Telephone | 718-442-9254
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Fax | 718-720-9107
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Authorized Official
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Title or Position | CEO
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Name | DR. DMITRIY VOLOTSENKO
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Credential | DDS
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Telephone | 718-442-9254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0419971
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License Number State | NY
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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 | 050410
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 051388
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 047879
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License Number State | NY
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