Provider Demographics
NPI:1639311319
Name:US DENTAL CHOICE P.L.L.C
Entity Type:Organization
Organization Name:US DENTAL CHOICE P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:IZRAILOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-294-8800
Mailing Address - Street 1:1963 GRAND CONCOURSE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4994
Mailing Address - Country:US
Mailing Address - Phone:718-294-8800
Mailing Address - Fax:718-731-5100
Practice Address - Street 1:1963 GRAND CONCOURSE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4994
Practice Address - Country:US
Practice Address - Phone:718-294-8800
Practice Address - Fax:718-731-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0506421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY050642OtherLICENSE