Provider Demographics
NPI:1780053108
Name:SBK DENTAL, LLC
Entity type:Organization
Organization Name:SBK DENTAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANKUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:347-708-9777
Mailing Address - Street 1:385 4TH AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3201
Mailing Address - Country:US
Mailing Address - Phone:347-708-9777
Mailing Address - Fax:347-708-9774
Practice Address - Street 1:385 4TH AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3201
Practice Address - Country:US
Practice Address - Phone:347-708-9777
Practice Address - Fax:347-708-9774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054655-1261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental