Organization
GROVE STREET DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VLADIMIR DRANOVSKY (PRESIDENT)
(201) 200-0222
Entity
Organization
Contact information
Practice address
175 NEWARK AVE, JERSEY CITY, NJ 07302
(201) 200-0222
(201) 435-7678
Mailing address
PO BOX 345, JERSEY CITY, NJ 07303
(201) 200-0222
(201) 435-7678
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DI20129
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5170907
—
NJ
Enumeration date
08/17/2006
Last updated
08/22/2020
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