Provider Demographics
NPI:1275516759
Name:NNN DENTAL PC
Entity Type:Organization
Organization Name:NNN DENTAL PC
Other - Org Name:ARTHUR NATANOV DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:NATANOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-459-2222
Mailing Address - Street 1:6442 108TH ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1611
Mailing Address - Country:US
Mailing Address - Phone:718-459-2222
Mailing Address - Fax:718-459-2222
Practice Address - Street 1:6442 108TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1611
Practice Address - Country:US
Practice Address - Phone:718-459-2222
Practice Address - Fax:718-459-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02146069Medicaid