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Organization
SP DENTAL, PC
Active
Organization
SP DENTAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SVETLANA PONOMAREVA DDS (DENTIST/OWNER)
(212) 234-2300
Entity
Organization
Contact information
Practice address
3627 BROADWAY, NEW YORK, NY 10031-2518
(212) 234-2300
(212) 234-2301
Mailing address
3627 BROADWAY, NEW YORK, NY 10031-2518
(212) 234-2300
(212) 234-2301
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
049663
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02224179
—
NY
Enumeration date
03/18/2008
Last updated
03/18/2008
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