Provider Demographics
NPI:1841289170
Name:PARK DENTAL CARE, PC
Entity type:Organization
Organization Name:PARK DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:P
Authorized Official - Last Name:KLEMPNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-565-5445
Mailing Address - Street 1:9101 63RD DR
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3849
Mailing Address - Country:US
Mailing Address - Phone:718-565-5445
Mailing Address - Fax:718-565-0952
Practice Address - Street 1:9101 63RD DR
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3849
Practice Address - Country:US
Practice Address - Phone:718-565-5445
Practice Address - Fax:718-565-0952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044129-1261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01380441Medicaid