Provider Demographics
NPI:1184779985
Name:MDS MANAGEMENT, INC.
Entity type:Organization
Organization Name:MDS MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KONDRATYEVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-963-0315
Mailing Address - Street 1:352 2ND STREET PIKE #396
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966
Mailing Address - Country:US
Mailing Address - Phone:215-745-5734
Mailing Address - Fax:
Practice Address - Street 1:433 MARKET ST STE 102
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102-1572
Practice Address - Country:US
Practice Address - Phone:856-963-0315
Practice Address - Fax:856-963-2369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 029186-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA864628OtherUNITED CONCORDIA GROUP ID
PA100963871-0001Medicaid