Provider Demographics
NPI:1578890414
Name:ARDEN DENTAL SERVICES P.C
Entity Type:Organization
Organization Name:ARDEN DENTAL SERVICES P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-769-1001
Mailing Address - Street 1:2610 OCEAN PKWY
Mailing Address - Street 2:SUITE L1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7747
Mailing Address - Country:US
Mailing Address - Phone:718-769-1001
Mailing Address - Fax:718-648-3143
Practice Address - Street 1:2610 OCEAN PKWY
Practice Address - Street 2:SUITE L1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7747
Practice Address - Country:US
Practice Address - Phone:718-769-1001
Practice Address - Fax:718-648-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0443291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01360049Medicaid