Provider Demographics
NPI:1730482076
Name:SPRING VALLEY ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:SPRING VALLEY ORTHODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:DRUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-471-7200
Mailing Address - Street 1:17 PERLMAN DR
Mailing Address - Street 2:STE B
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5281
Mailing Address - Country:US
Mailing Address - Phone:845-352-2100
Mailing Address - Fax:845-352-2199
Practice Address - Street 1:17 PERLMAN DR
Practice Address - Street 2:STE B
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5281
Practice Address - Country:US
Practice Address - Phone:845-352-2100
Practice Address - Fax:845-352-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0472181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty