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NPI Code Detail

MEDICARE: IK DENTAL

MEDICARE: IK DENTAL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist045540NY
2332B00000XDurable Medical Equipment & Medical Supplies045540NY

General Provider Information

NPI Number : 1104093814
Entity Type Code : Organization
Provider Name (Legal Business Name) : IK DENTAL
Provider Business Mailing Address
First Line : 4405 BROADWAY
Second Line :
City : NEW YORK
State : NY
Zip : 10040-4014
Country : US
Telephone Number : 212-568-1500
Fax Number : 855-201-3647
Provider Business Practice Location Address
First Line : 4405 BROADWAY
Second Line :
City : NEW YORK
State : NY
Zip : 10040-4014
Country : US
Telephone Number : 212-568-1500
Fax Number : 855-201-3647
Authorized Official
Title or Position : AUTHERIZED OFFICIAL
Name : DR. IGOR KLEBANOV
Credential : DDS
Telephone Number : 212-568-1500
Provider Enumeration Date : 05/12/2008
Last Update Date : 07/21/2022

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Directions to “IK DENTAL ” Practice Location

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