Provider Demographics
NPI:1154466746
Name:DOUBLE CARE DENTAL PC
Entity type:Organization
Organization Name:DOUBLE CARE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOFIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUDINOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-339-1811
Mailing Address - Street 1:2200 OCEAN AVENUE
Mailing Address - Street 2:SUITE 1 U
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2249
Mailing Address - Country:US
Mailing Address - Phone:718-339-1811
Mailing Address - Fax:718-627-6843
Practice Address - Street 1:2200 OCEAN AVENUE
Practice Address - Street 2:SUITE 1 U
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2249
Practice Address - Country:US
Practice Address - Phone:718-339-1811
Practice Address - Fax:718-339-1811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047382122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01789922Medicaid
NYD000598OtherMHS AMERICHOCE
NYBC5631925OtherDEA