Provider Demographics
NPI:1578701835
Name:DENTAL CARE OF RIDGEWOOD, P.C.
Entity Type:Organization
Organization Name:DENTAL CARE OF RIDGEWOOD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESPONSIBLE PARTY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-417-6300
Mailing Address - Street 1:5647 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-4744
Mailing Address - Country:US
Mailing Address - Phone:718-417-6300
Mailing Address - Fax:718-417-3535
Practice Address - Street 1:5647 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-4744
Practice Address - Country:US
Practice Address - Phone:718-417-6300
Practice Address - Fax:718-417-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-25
Last Update Date:2009-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054039261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental