Provider Demographics
NPI:1770565046
Name:R V DENTAL PC
Entity type:Organization
Organization Name:R V DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:REBECA
Authorized Official - Middle Name:VALERY
Authorized Official - Last Name:ROMOSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-777-8144
Mailing Address - Street 1:1103 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-5023
Mailing Address - Country:US
Mailing Address - Phone:718-777-8144
Mailing Address - Fax:718-777-8166
Practice Address - Street 1:1103 36TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-5023
Practice Address - Country:US
Practice Address - Phone:718-777-8144
Practice Address - Fax:718-777-8166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty