Organization
ELDRIDGE DENTAL CARE P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DMITRIY VOLOTSENKO DDS (CEO)
(718) 442-9254
Entity
Organization
Contact information
Practice address
1432 FOREST AVE, STATEN ISLAND, NY 10302-2204
(718) 442-9254
(718) 720-9107
Mailing address
1432 FOREST AVE, STATEN ISLAND, NY 10302-2204
(718) 442-9254
(718) 720-9107
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
0419971
NY
1223G0001X
General Practice Dentistry
Primary
047879
NY
1223G0001X
General Practice Dentistry
050410
NY
1223G0001X
General Practice Dentistry
051388
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01954503
—
NY
Enumeration date
01/31/2007
Last updated
08/22/2020
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