Provider Demographics
NPI:1518259860
Name:SEREBRO DENTAL P.C.
Entity Type:Organization
Organization Name:SEREBRO DENTAL P.C.
Other - Org Name:SEREBRO DENTAL P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAKSIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SEREBRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-263-4142
Mailing Address - Street 1:910 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-1838
Mailing Address - Country:US
Mailing Address - Phone:914-263-4142
Mailing Address - Fax:
Practice Address - Street 1:910 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-1838
Practice Address - Country:US
Practice Address - Phone:914-263-4142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0102981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty