Provider Demographics
NPI:1104047125
Name:DIMOVA, RADOST NIKOLOVA (DDS)
Entity type:Individual
Prefix:DR
First Name:RADOST
Middle Name:NIKOLOVA
Last Name:DIMOVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 E. 1ST
Mailing Address - Street 2:#2D
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10009
Mailing Address - Country:US
Mailing Address - Phone:212-563-0095
Mailing Address - Fax:
Practice Address - Street 1:14 PENN PLAZA
Practice Address - Street 2:SUITE 400
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-563-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0516811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice