Provider Demographics
NPI:1114265741
Name:BROOKLYN DENTAL, P.C.
Entity Type:Organization
Organization Name:BROOKLYN DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHIHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-333-9900
Mailing Address - Street 1:7 BAY 28TH ST
Mailing Address - Street 2:SUITE1, 2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4005
Mailing Address - Country:US
Mailing Address - Phone:718-333-9900
Mailing Address - Fax:718-333-9906
Practice Address - Street 1:7 BAY 28TH ST
Practice Address - Street 2:SUITE1, 2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4005
Practice Address - Country:US
Practice Address - Phone:718-333-9900
Practice Address - Fax:718-333-9906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051572122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty