Organization
BAY RIDGE DENTAL GROUP, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VERA PAVLOVA DDS (PARTNER)
(718) 836-1716
Entity
Organization
Contact information
Practice address
8415 4TH AVE, A-16, BROOKLYN, NY 11209-4654
(718) 836-1716
(718) 836-3642
Mailing address
8415 4TH AVE, A-16, BROOKLYN, NY 11209-4654
(718) 836-1716
(718) 836-3642
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
049515
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02757913
—
NY
Enumeration date
02/13/2007
Last updated
08/22/2020
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