Provider Demographics
NPI:1205093556
Name:AR&AR PROGRESSIVE DENTISTRY
Entity type:Organization
Organization Name:AR&AR PROGRESSIVE DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:RABICHEV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-725-1111
Mailing Address - Street 1:50 PARK AVE STE 1-G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3075
Mailing Address - Country:US
Mailing Address - Phone:212-725-1111
Mailing Address - Fax:212-725-1119
Practice Address - Street 1:50 PARK AVE STE 1-G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3075
Practice Address - Country:US
Practice Address - Phone:212-725-1111
Practice Address - Fax:212-725-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044394122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01537379Medicaid