Provider Demographics
NPI:1881197689
Name:AMERICHOICE DENTAL CARE PC
Entity type:Organization
Organization Name:AMERICHOICE DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAVULUNOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-459-0591
Mailing Address - Street 1:6511 108TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1847
Mailing Address - Country:US
Mailing Address - Phone:718-459-0591
Mailing Address - Fax:718-275-1355
Practice Address - Street 1:6511 108TH ST STE A
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1847
Practice Address - Country:US
Practice Address - Phone:718-459-0591
Practice Address - Fax:718-275-1355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-18
Last Update Date:2018-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01778936261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01778936Medicaid