MEDICARE: RSN DENTAL PC

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
1	1223G0001X	General Practice Dentistry	048325	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285741140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RSN DENTAL PC

Provider Business Mailing Address
First Line	:	3589 RICHMOND AVE
Second Line	:	1ST FLOOR
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3410
Country	:	US
Telephone Number	:	718-317-1737
Fax Number	:	718-317-1739

Provider Business Practice Location Address
First Line	:	3589 RICHMOND AVE
Second Line	:	1ST FLOOR
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3410
Country	:	US
Telephone Number	:	718-317-1737
Fax Number	:	718-317-1739

Authorized Official
Title or Position	:	PRACTITIONER/PRESIDENT
Name	:	DR. VLADISLAV SHIKHMANTER
Credential	:	DDS
Telephone Number	:	718-317-1737

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	08/22/2020

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Directions to “RSN DENTAL PC ” Practice Location

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