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General NPI Number Information
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NPI Number | 1821162645
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Entity Type | Organization
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Legal Business Name | LITVINOV DENTAL LLC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 333 EAST 79 ST STE LU
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City | NEW YORK
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State | NY
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Zip | 10021
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Country | US
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Telephone | 212-744-5544
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Fax | 212-746-5556
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Provider Business Mailing Address
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Address Line | 333 EAST 79 ST STE LU
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City | NEW YORK
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State | NY
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Zip | 10021
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Country | US
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Telephone | 212-744-5544
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Fax | 212-746-5556
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Authorized Official
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Title or Position | OWNER
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Name | MR. SERGEY E LITVINOV
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Credential | DDS
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Telephone | 212-744-5544
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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 | 044176
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License Number State | NY
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