Provider Demographics
NPI:1952814998
Name:NO TEARS DENTAL PC
Entity Type:Organization
Organization Name:NO TEARS DENTAL PC
Other - Org Name:STATE FAMILY DENTAL CARE PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KONSTANTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KISELEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-554-4299
Mailing Address - Street 1:42 GIFFORDS LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2014
Mailing Address - Country:US
Mailing Address - Phone:718-554-4299
Mailing Address - Fax:
Practice Address - Street 1:475 SAINT MARKS PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2408
Practice Address - Country:US
Practice Address - Phone:718-273-0225
Practice Address - Fax:718-273-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental