Provider Demographics
NPI:1093586638
Name:86 STREET DENTAL PC
Entity Type:Organization
Organization Name:86 STREET DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DMITRIY
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLOTSENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-797-8052
Mailing Address - Street 1:2155 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-3205
Mailing Address - Country:US
Mailing Address - Phone:718-509-4888
Mailing Address - Fax:
Practice Address - Street 1:2155 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3205
Practice Address - Country:US
Practice Address - Phone:718-509-4888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty