Provider Demographics
NPI:1093941361
Name:VATRENKO GITLIN DENTAL OFFICES PC
Entity Type:Organization
Organization Name:VATRENKO GITLIN DENTAL OFFICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GITLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-769-4116
Mailing Address - Street 1:178 BRIGHTON 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5327
Mailing Address - Country:US
Mailing Address - Phone:718-769-4116
Mailing Address - Fax:
Practice Address - Street 1:178 BRIGHTON 11TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5327
Practice Address - Country:US
Practice Address - Phone:718-769-4116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041069122300000X
NY045231122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty