Provider Demographics
NPI:1356704266
Name:NY DENTAL PC
Entity type:Organization
Organization Name:NY DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:YEGOROV
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-753-8444
Mailing Address - Street 1:83 CAMBRIDGE ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4181
Mailing Address - Country:US
Mailing Address - Phone:781-265-4500
Mailing Address - Fax:781-265-4246
Practice Address - Street 1:83 CAMBRIDGE ST STE 3A
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4181
Practice Address - Country:US
Practice Address - Phone:781-265-4500
Practice Address - Fax:781-265-4246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855745261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental