Provider Demographics
NPI:1225636400
Name:NK DENTAL PC
Entity Type:Organization
Organization Name:NK DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKILASHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:929-300-0702
Mailing Address - Street 1:109 N 12TH ST STE 607
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-1002
Mailing Address - Country:US
Mailing Address - Phone:929-300-0702
Mailing Address - Fax:929-300-0706
Practice Address - Street 1:109 N 12TH ST STE 607
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-1002
Practice Address - Country:US
Practice Address - Phone:929-300-0702
Practice Address - Fax:929-300-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-11
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty