=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912187600
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL PARK SOUTH DENTAL CARE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2007
-----------------------------------------------------
Last Update Date | 11/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 CENTRAL PARK S SUITE 109
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-1436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-565-5445
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 CENTRAL PARK S SUITE 109
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-1436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-565-5445
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. OLEG KLEMPNER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 718-565-5445
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 044129-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------