Provider Demographics
NPI:1316381239
Name:LITVINOV DENTAL PC
Entity Type:Organization
Organization Name:LITVINOV DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:V
Authorized Official - Last Name:LITVINOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-375-0500
Mailing Address - Street 1:1426 KINGS HWY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2092
Mailing Address - Country:US
Mailing Address - Phone:718-375-0500
Mailing Address - Fax:718-942-5060
Practice Address - Street 1:1426 KINGS HWY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2092
Practice Address - Country:US
Practice Address - Phone:718-375-0500
Practice Address - Fax:718-942-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty