Provider Demographics
NPI:1437714789
Name:DENTAL EXCELLENCE PC
Entity Type:Organization
Organization Name:DENTAL EXCELLENCE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUSIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-877-7475
Mailing Address - Street 1:92 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SCHUYLERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12871-1301
Mailing Address - Country:US
Mailing Address - Phone:518-695-9015
Mailing Address - Fax:
Practice Address - Street 1:92 BROAD ST
Practice Address - Street 2:
Practice Address - City:SCHUYLERVILLE
Practice Address - State:NY
Practice Address - Zip Code:12871-1301
Practice Address - Country:US
Practice Address - Phone:518-695-9015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL EXCELLLENCE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-02
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental