Organization
SUPERIOR DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SVETLANA PONOMAREVA DDS (OWNER)
(718) 329-2929
Entity
Organization
Contact information
Practice address
2475 GRAND CONCOURSE, BRONX, NY 10468-5443
(718) 329-2929
(718) 329-2930
Mailing address
2475 GRAND CONCOURSE, BRONX, NY 10468-5443
(718) 329-2929
(718) 329-2930
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
049663
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02224179
—
NY
Enumeration date
01/29/2009
Last updated
01/29/2009
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