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Organization
OPEN DENTAL PC
Active
Organization
OPEN DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANASTASIA KOVALEVA (OFFICE MANAGER)
(718) 618-7564
Entity
Organization
Contact information
Practice address
300 E 96TH ST APT 6E, NEW YORK, NY 10128-3869
(734) 883-4406
Mailing address
300 E 96TH ST APT 6E, NEW YORK, NY 10128-3869
(734) 883-4406
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
056676
NY
Other
Enumeration date
06/23/2014
Last updated
06/23/2014
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