Provider Demographics
NPI:1881670008
Name:AK AVC 'U' DENTAL CARE PC
Entity Type:Organization
Organization Name:AK AVC 'U' DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:EZRA
Authorized Official - Last Name:KADAA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-627-3682
Mailing Address - Street 1:428 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4049
Mailing Address - Country:US
Mailing Address - Phone:718-627-3682
Mailing Address - Fax:718-627-3683
Practice Address - Street 1:428 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4049
Practice Address - Country:US
Practice Address - Phone:718-627-3682
Practice Address - Fax:718-627-3683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047740122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01877747Medicaid