Provider Demographics
NPI:1689098105
Name:BROOKLYN DENTAL GROUP, P.C.
Entity Type:Organization
Organization Name:BROOKLYN DENTAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-946-0500
Mailing Address - Street 1:PO BOX 300414
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-0414
Mailing Address - Country:US
Mailing Address - Phone:718-946-0500
Mailing Address - Fax:718-339-4810
Practice Address - Street 1:2270 OCEAN AVE
Practice Address - Street 2:SUITE 1D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3038
Practice Address - Country:US
Practice Address - Phone:718-946-0500
Practice Address - Fax:718-339-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048971122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02189568Medicaid