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General NPI Number Information
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NPI Number | 1427349489
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Entity Type | Organization
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Legal Business Name | RICHMOND AVE ORTHODONTICS, PLLC
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 2025 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3937
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Country | US
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Telephone | 718-477-7711
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Fax |
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Provider Business Mailing Address
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Address Line | 2025 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3937
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Country | US
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Telephone | 718-477-7711
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Fax |
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. OLEG DRUT
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Credential | DDS
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Telephone | 718-477-7711
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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 | 047348-1
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License Number State | NY
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