Provider Demographics
NPI:1972818474
Name:NEW BRITAIN DENTAL CENTER
Entity Type:Organization
Organization Name:NEW BRITAIN DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:MR
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-247-5449
Mailing Address - Street 1:108A WEST BUTLER AVE.
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-5108
Mailing Address - Country:US
Mailing Address - Phone:267-247-5449
Mailing Address - Fax:267-247-5462
Practice Address - Street 1:108 W BUTLER AVE
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:PA
Practice Address - Zip Code:18901-5108
Practice Address - Country:US
Practice Address - Phone:267-247-5449
Practice Address - Fax:267-247-5462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0361131223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010462950001Medicaid