Provider Demographics
NPI:1114522232
Name:PROHEALTH DENTAL PLLC
Entity Type:Organization
Organization Name:PROHEALTH DENTAL PLLC
Other - Org Name:WEST DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOROBEYNYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-654-4400
Mailing Address - Street 1:3333 NEW HYDE PARK RD STE 310
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1205
Mailing Address - Country:US
Mailing Address - Phone:516-654-4400
Mailing Address - Fax:
Practice Address - Street 1:216 MARKET ST
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-7607
Practice Address - Country:US
Practice Address - Phone:914-639-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROHEALTH DENTAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-04
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty