Provider Demographics
NPI:1588647358
Name:KIPNIS, POLINA (DDS)
Entity Type:Individual
Prefix:MS
First Name:POLINA
Middle Name:
Last Name:KIPNIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:POLINA
Other - Middle Name:
Other - Last Name:KIPNIS-TSEITLINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1916 KINGS HWY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1916 KINGS HWY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1314
Practice Address - Country:US
Practice Address - Phone:718-627-8200
Practice Address - Fax:718-627-8200
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04387511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC1279OtherHEALTH PLEX
NY01294619Medicaid
NY016715OtherDORAL