Provider Demographics
NPI:1144428384
Name:NEW HORIZON DENTAL, P.C
Entity Type:Organization
Organization Name:NEW HORIZON DENTAL, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKHAILOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-861-8060
Mailing Address - Street 1:961EAST 174 ST
Mailing Address - Street 2:SUITE B 150
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460
Mailing Address - Country:US
Mailing Address - Phone:718-861-8060
Mailing Address - Fax:
Practice Address - Street 1:961EAST 174 ST.
Practice Address - Street 2:SUITE B 150
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460
Practice Address - Country:US
Practice Address - Phone:718-861-8060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0417961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01100018Medicaid