Provider Demographics
NPI:1598198269
Name:CHERNOMORDIK, VERA (DMD)
Entity Type:Individual
Prefix:DR
First Name:VERA
Middle Name:
Last Name:CHERNOMORDIK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 DITMAS AVE
Mailing Address - Street 2:MEDICAL DENTAL PLAZA, FIRST FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4919
Mailing Address - Country:US
Mailing Address - Phone:718-972-1644
Mailing Address - Fax:
Practice Address - Street 1:401 DITMAS AVE
Practice Address - Street 2:MEDICAL DENTAL PLAZA, FIRST FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4919
Practice Address - Country:US
Practice Address - Phone:718-972-1644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0568661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice