Provider Demographics
NPI:1811739832
Name:RA DENTAL CARE PC
Entity type:Organization
Organization Name:RA DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:AKILOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-533-0043
Mailing Address - Street 1:7002 FOREST AVE APT 1L
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-5620
Mailing Address - Country:US
Mailing Address - Phone:718-821-4128
Mailing Address - Fax:
Practice Address - Street 1:7002 FOREST AVE APT 1L
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5620
Practice Address - Country:US
Practice Address - Phone:718-821-4128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty