Provider Demographics
NPI:1811552367
Name:LITTLE TOOTH PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:LITTLE TOOTH PEDIATRIC DENTISTRY PLLC
Other - Org Name:FORT GREENE PEDIATRIC DENTISTRY PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEYLIKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-326-0205
Mailing Address - Street 1:55 GREENE AVE STE LLC
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-6432
Mailing Address - Country:US
Mailing Address - Phone:718-230-7676
Mailing Address - Fax:718-230-7776
Practice Address - Street 1:55 GREENE AVE STE LLC
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-6432
Practice Address - Country:US
Practice Address - Phone:718-230-7676
Practice Address - Fax:718-230-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty