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General NPI Number Information
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NPI Number | 1770143364
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Entity Type | Organization
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Legal Business Name | FAMILY DENTAL PC
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 645 W 207TH ST
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City | NEW YORK
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State | NY
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Zip | 10034-2654
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Country | US
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Telephone | 212-304-1666
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Fax | 212-304-1666
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Provider Business Mailing Address
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Address Line | 645 W 207TH ST
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City | NEW YORK
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State | NY
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Zip | 10034-2654
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Country | US
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Telephone | 212-304-1666
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Fax | 212-304-1666
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Authorized Official
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Title or Position | DENTIST
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Name | DR. RUDOLF DDS AKILOV
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Credential | DDS
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Telephone | 212-304-1666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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