Provider Demographics
NPI:1326158981
Name:NEW CENTURY DENTAL PC
Entity Type:Organization
Organization Name:NEW CENTURY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:G
Authorized Official - Last Name:ONATSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-621-0827
Mailing Address - Street 1:2960 OCEAN AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3202
Mailing Address - Country:US
Mailing Address - Phone:718-621-0827
Mailing Address - Fax:718-621-0829
Practice Address - Street 1:2960 OCEAN AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3202
Practice Address - Country:US
Practice Address - Phone:718-621-0827
Practice Address - Fax:718-621-0829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01763831Medicaid