Provider Demographics
NPI:1902228158
Name:CUTE PEARLS DENTAL CARE PC
Entity Type:Organization
Organization Name:CUTE PEARLS DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:ALEXEY
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-312-7690
Mailing Address - Street 1:1749 GRAND CONCOURSE
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-8241
Mailing Address - Country:US
Mailing Address - Phone:718-466-2222
Mailing Address - Fax:718-466-6555
Practice Address - Street 1:1749 GRAND CONCOURSE
Practice Address - Street 2:SUITE 1E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-8241
Practice Address - Country:US
Practice Address - Phone:718-466-2222
Practice Address - Fax:718-466-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055155305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03249378Medicaid