Provider Demographics
NPI:1780763490
Name:PERFECT DENTAL PC
Entity type:Organization
Organization Name:PERFECT DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIYAHU
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAKHANE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-972-7200
Mailing Address - Street 1:1272 50TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-6510
Mailing Address - Country:US
Mailing Address - Phone:718-972-7200
Mailing Address - Fax:
Practice Address - Street 1:1272 50TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-6510
Practice Address - Country:US
Practice Address - Phone:718-972-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0461901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID