Provider Demographics
NPI:1356461925
Name:R.L. DENTAL SERVICES, P.C.
Entity Type:Organization
Organization Name:R.L. DENTAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:LICHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-251-5551
Mailing Address - Street 1:6410 VETERANS AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5639
Mailing Address - Country:US
Mailing Address - Phone:718-251-5551
Mailing Address - Fax:718-251-4425
Practice Address - Street 1:6410 VETERANS AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5639
Practice Address - Country:US
Practice Address - Phone:718-251-5551
Practice Address - Fax:718-251-4425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029218-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00294019Medicaid