Organization
JEROME DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NATALIYA GUBENKO DDS (EXECUTIVE OFFICER)
(718) 615-2030
Entity
Organization
Contact information
Practice address
1810 JEROME AVE, 2ND FLOOR, BROOKLYN, NY 11235-3621
(718) 615-2030
(718) 615-2030
Mailing address
1810 JEROME AVE, 2ND FLOOR, BROOKLYN, NY 11235-3621
(718) 615-2030
(718) 615-2030
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
046347
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01663405
—
NY
Enumeration date
02/14/2007
Last updated
07/15/2007
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