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Organization
PARKSIDE DENTAL PC
Active
Organization
PARKSIDE DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SERGE KUPETZ DDS (DOCTOR OWNER)
(718) 462-7436
Entity
Organization
Contact information
Practice address
325 OCEAN AVE, BROOKLYN, NY 11225
(718) 462-7436
(718) 462-2418
Mailing address
325 OCEAN AVE, BROOKLYN, NY 11225
(718) 462-7436
(718) 462-2418
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
049097
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02119991
—
NY
Enumeration date
09/26/2006
Last updated
06/07/2013
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