Provider Demographics
NPI:1003338674
Name:NEIGHBORHOOD DENTAL OF BUSHWICK PC
Entity Type:Organization
Organization Name:NEIGHBORHOOD DENTAL OF BUSHWICK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIHNYONOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-963-9500
Mailing Address - Street 1:291 KNICKERBOCKER AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-3103
Mailing Address - Country:US
Mailing Address - Phone:718-963-9500
Mailing Address - Fax:
Practice Address - Street 1:291 KNICKERBOCKER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237
Practice Address - Country:US
Practice Address - Phone:718-963-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty