# OPEN DENTAL PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114332798
- **Authorized official:** ANASTASIA KOVALEVA (OFFICE MANAGER)
- **Authorized official phone:** (718) 618-7564

## Contact information

- **Practice address:** 300 E 96TH ST APT 6E, NEW YORK, NY 10128-3869
- **Practice address phone:** (734) 883-4406
- **Mailing address:** 300 E 96TH ST APT 6E, NEW YORK, NY 10128-3869
- **Mailing address phone:** (734) 883-4406

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 056676 | NY | Yes |

## Other

- **Enumeration date:** 06/23/2014
- **Last updated:** 06/23/2014