| 125th Street Dental Llp | |
|
437 W 125th St New York NY 10027-4201 | |
| (646) 827-9819 | |
| (646) 827-0510 |
| Full Name | 125th Street Dental Llp |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 437 W 125th St, New York, New York |
| Authorized Official Name and Position | Serguei Kopetskov (PRESIDENT) |
| Authorized Official Contact | 6468279819 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 125th Street Dental Llp 437 W 125th St New York NY 10027-4201 Ph: (646) 827-9819 | 125th Street Dental Llp 437 W 125th St New York NY 10027-4201 Ph: (646) 827-9819 |
| NPI Number | 1861523771 |
|---|---|
| Provider Enumeration Date | 03/09/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861523771 | NPI | - | NPPES |
| 02772787 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 049097 (New York) | Primary |
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