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Organization

HOLLIS ADVANCED DENTAL CARE P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BENJAMIN V KATAYEV D.D.S. (PRESIDENT)
(718) 454-7418
Entity
Organization

Contact information

Practice address
19002 JAMAICA AVE, 2 FLOOR, HOLLIS, NY 11423-2516
(718) 454-7418
(718) 217-2657
Mailing address
19002 JAMAICA AVE, 2 FLOOR, HOLLIS, NY 11423-2516
(718) 454-7418
(718) 217-2657

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
NY
1223P0300X
Periodontics
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
011896900
NY
05
02587795
NY
Enumeration date
08/27/2008
Last updated
08/27/2008
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