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NPI Code Detail

MEDICARE: NYC FAMILY DENTAL CARE P.C.

MEDICARE: NYC FAMILY DENTAL CARE P.C.
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
11223G0001XGeneral Practice Dentistry054967NY

General Provider Information

NPI Number : 1720409303
Entity Type Code : Organization
Provider Name (Legal Business Name) : NYC FAMILY DENTAL CARE P.C.
Provider Business Mailing Address
First Line : 3002 MERMAID AVENUE
Second Line :
City : BROOKLYN
State : NY
Zip : 11224-2256
Country : US
Telephone Number : 718-975-4475
Fax Number : 718-975-4477
Provider Business Practice Location Address
First Line : 3002 MERMAID AVENUE
Second Line :
City : BROOKLYN
State : NY
Zip : 11224-2256
Country : US
Telephone Number : 718-975-4475
Fax Number : 718-975-4477
Authorized Official
Title or Position : PRESIDENT
Name : ANATOLIY KONOVALOV
Credential : D.M.D
Telephone Number : 718-975-4475
Provider Enumeration Date : 12/26/2013
Last Update Date : 12/26/2013

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