Organization
MILLENNIUM SMILE DENTISTRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VITALIY FABRIKANT DMD (PRESIDENT)
(212) 740-7568
Entity
Organization
Contact information
Practice address
120 CABRINI BLVD, #10, NEW YORK, NY 10033-3438
(212) 740-7568
(212) 740-7568
Mailing address
120 CABRINI BLVD, #10, NEW YORK, NY 10033-3438
(212) 740-7568
(212) 740-7568
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
048425
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02525684
—
NY
Enumeration date
10/04/2006
Last updated
08/22/2020
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