Provider Demographics
NPI:1760653323
Name:ATLANTIC DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:ATLANTIC DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRIJ
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-643-9010
Mailing Address - Street 1:502A ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1813
Mailing Address - Country:US
Mailing Address - Phone:718-643-9010
Mailing Address - Fax:718-643-9020
Practice Address - Street 1:502A ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1813
Practice Address - Country:US
Practice Address - Phone:718-643-9010
Practice Address - Fax:718-643-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050644-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02405356Medicaid