Provider Demographics
NPI:1851987622
Name:RI DENTAL CARE PC
Entity Type:Organization
Organization Name:RI DENTAL CARE PC
Other - Org Name:UNIVERSITY DENTAL ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAKHAROV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-897-9745
Mailing Address - Street 1:2505 UNIVERSITY AVE FRNT 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-4011
Mailing Address - Country:US
Mailing Address - Phone:718-733-6600
Mailing Address - Fax:
Practice Address - Street 1:2505 UNIVERSITY AVE FRNT 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-4011
Practice Address - Country:US
Practice Address - Phone:718-733-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty