Provider Demographics
NPI:1568697746
Name:GAMA DENTAL PC
Entity Type:Organization
Organization Name:GAMA DENTAL PC
Other - Org Name:GAMA DENTAL PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAKSIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHELEMSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-375-9090
Mailing Address - Street 1:270 AVENUE P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4947
Mailing Address - Country:US
Mailing Address - Phone:718-375-9090
Mailing Address - Fax:718-375-6618
Practice Address - Street 1:270 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4947
Practice Address - Country:US
Practice Address - Phone:718-375-9090
Practice Address - Fax:718-375-6618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0448361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01421021Medicaid