Provider Demographics
NPI:1861665481
Name:I.B. DENTAL PC
Entity Type:Organization
Organization Name:I.B. DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANETS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-934-0050
Mailing Address - Street 1:1601 GRAVESEND NECK RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4426
Mailing Address - Country:US
Mailing Address - Phone:718-934-0050
Mailing Address - Fax:718-934-0063
Practice Address - Street 1:1601 GRAVESEND NECK RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4426
Practice Address - Country:US
Practice Address - Phone:718-934-0050
Practice Address - Fax:718-934-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02941940Medicaid