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General NPI Number Information
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NPI Number | 1619405412
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Entity Type | Organization
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Legal Business Name | AVPERIODONTICS PLLC
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Dates
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Enumeration Date | 05/24/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 274 MADISON AVE RM 202
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City | NEW YORK
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State | NY
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Zip | 10016-0717
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Country | US
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Telephone | 929-293-0200
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Fax | 212-889-8891
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Provider Business Mailing Address
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Address Line | 274 MADISON AVE RM 202
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City | NEW YORK
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State | NY
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Zip | 10016-0717
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Country | US
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Telephone | 929-293-0200
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Fax | 212-889-8891
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALEXANDER VOLCHONOK
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Credential | DMD, MS
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Telephone | 929-293-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 50058006
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License Number State | NY
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