Provider Demographics
NPI:1205563822
Name:DENTAL VISION,PC
Entity type:Organization
Organization Name:DENTAL VISION,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TETYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:POHORLETSKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-323-1715
Mailing Address - Street 1:115 NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-2154
Mailing Address - Country:US
Mailing Address - Phone:347-323-1715
Mailing Address - Fax:
Practice Address - Street 1:115 NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-2154
Practice Address - Country:US
Practice Address - Phone:203-751-9667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty