Provider Demographics
NPI:1982677647
Name:OVRUTSKY, DMITRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DMITRY
Middle Name:
Last Name:OVRUTSKY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 N WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2316
Mailing Address - Country:US
Mailing Address - Phone:845-735-7770
Mailing Address - Fax:845-735-3986
Practice Address - Street 1:5 N WILLIAM ST
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2316
Practice Address - Country:US
Practice Address - Phone:845-735-7770
Practice Address - Fax:845-735-3986
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0501281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02373586Medicaid