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General NPI Number Information
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NPI Number | 1629336664
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Entity Type | Organization
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Legal Business Name | YES DENTAL OF NY, PLLC
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 1420 ST. NICHOLAS AVE, 2 FL
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City | NEW YORK
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State | NY
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Zip | 10033-4050
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Country | US
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Telephone | 212-781-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 ST. NICHOLAS AVE, 2 FL
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City | NEW YORK
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State | NY
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Zip | 10033-4050
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Country | US
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Telephone | 212-781-0700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DMITRIY VOLOTSENKO
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Credential | DDS
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Telephone | 212-781-0700
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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 | 052869
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 047879
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License Number State | NY
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