Provider Demographics
NPI:1598239493
Name:NYC DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:NYC DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEMYON
Authorized Official - Middle Name:
Authorized Official - Last Name:TILIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-487-4888
Mailing Address - Street 1:401 76TH ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3215
Mailing Address - Country:US
Mailing Address - Phone:347-487-4888
Mailing Address - Fax:347-524-6886
Practice Address - Street 1:401 76TH ST STE 1A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3215
Practice Address - Country:US
Practice Address - Phone:347-487-4888
Practice Address - Fax:347-524-6886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental