Provider Demographics
NPI:1437297686
Name:GENNADIY KRAVETS DMD PLLC
Entity Type:Organization
Organization Name:GENNADIY KRAVETS DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GENNADIY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAVETS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-388-4613
Mailing Address - Street 1:202 UNION AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-7467
Mailing Address - Country:US
Mailing Address - Phone:718-388-4613
Mailing Address - Fax:718-388-4613
Practice Address - Street 1:202 UNION AVE
Practice Address - Street 2:SUITE D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7467
Practice Address - Country:US
Practice Address - Phone:718-388-4613
Practice Address - Fax:718-388-4613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0525941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02721328Medicaid