Organization
A R ADVANCED DENTAL GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROMAN IZMAILOV DDS (DENTIST)
(845) 222-3330
Entity
Organization
Contact information
Practice address
5C MEDICAL PARK DR, POMONA, NY 10970-3516
(845) 364-9400
(845) 364-0284
Mailing address
5C MEDICAL PARK DR, POMONA, NY 10970-3516
(845) 364-9400
(845) 364-0284
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022-05-383
—
NY
01
—
11713
DORAL LOCATION NUMBER
NY
Enumeration date
01/26/2007
Last updated
06/16/2008
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