| Sp Dental, Pc | |
|
3627 Broadway New York NY 10031-2518 | |
| (212) 234-2300 | |
| (212) 234-2301 |
| Full Name | Sp Dental, Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3627 Broadway, New York, New York |
| Authorized Official Name and Position | Svetlana Ponomareva (DENTIST/OWNER) |
| Authorized Official Contact | 2122342300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sp Dental, Pc 3627 Broadway New York NY 10031-2518 Ph: (212) 234-2300 | Sp Dental, Pc 3627 Broadway New York NY 10031-2518 Ph: (212) 234-2300 |
| NPI Number | 1932370970 |
|---|---|
| Provider Enumeration Date | 03/18/2008 |
| Last Update Date | 03/18/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932370970 | NPI | - | NPPES |
| 02224179 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 049663 (New York) | Primary |
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