Provider Demographics
NPI:1760607493
Name:MIDCITY DENTAL GROUP
Entity Type:Organization
Organization Name:MIDCITY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IOSIF
Authorized Official - Middle Name:
Authorized Official - Last Name:UVAYDOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-951-2261
Mailing Address - Street 1:2101 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1509
Mailing Address - Country:US
Mailing Address - Phone:718-951-2261
Mailing Address - Fax:718-951-2018
Practice Address - Street 1:2101 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1509
Practice Address - Country:US
Practice Address - Phone:718-951-2261
Practice Address - Fax:718-951-2018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02338829Medicaid