Provider Demographics
NPI:1558859736
Name:DITMAS PARK DENTAL, PC
Entity Type:Organization
Organization Name:DITMAS PARK DENTAL, PC
Other - Org Name:FLATBUSH DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDIYEV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-888-9300
Mailing Address - Street 1:1218 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7667
Mailing Address - Country:US
Mailing Address - Phone:718-255-8555
Mailing Address - Fax:
Practice Address - Street 1:1218 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7667
Practice Address - Country:US
Practice Address - Phone:718-255-8555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053946122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03034879Medicaid