Provider Demographics
NPI:1487816435
Name:QUALITY DENTAL
Entity Type:Organization
Organization Name:QUALITY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEREZOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-256-3144
Mailing Address - Street 1:2626 E 14TH ST
Mailing Address - Street 2:STE 206
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3966
Mailing Address - Country:US
Mailing Address - Phone:718-256-3144
Mailing Address - Fax:718-256-3181
Practice Address - Street 1:2626 E 14TH ST
Practice Address - Street 2:STE 206
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3966
Practice Address - Country:US
Practice Address - Phone:718-256-3144
Practice Address - Fax:718-256-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048472261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02052615Medicaid