Provider Demographics
NPI:1164577268
Name:BROOKLYN DENTAL CARE, PC
Entity Type:Organization
Organization Name:BROOKLYN DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-260-9293
Mailing Address - Street 1:409 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5103
Mailing Address - Country:US
Mailing Address - Phone:718-260-9293
Mailing Address - Fax:718-260-9484
Practice Address - Street 1:409 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5103
Practice Address - Country:US
Practice Address - Phone:718-260-9293
Practice Address - Fax:718-260-9484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0355481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty