Organization
ADVANCED DENTAL OF NEW YORK PC
Active
Other names
Advanced Dental Specialties of NY
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN KATAYEV DDS (PRESIDENT)
(718) 740-6000
Entity
Organization
Contact information
Practice address
19711 HILLSIDE AVE, HOLLIS, NY 11423-2126
(718) 740-6000
(718) 740-6004
Mailing address
197-11 HILLSIDE AVENUE, HOLLIS, NY 11423-2516
(718) 740-6000
(718) 740-6004
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
054577
NY
1223P0300X
Periodontics
053253
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
053869
NY
Other
Enumeration date
02/24/2011
Last updated
12/15/2017
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