Provider Demographics
NPI:1366914806
Name:ELIKASHVILI & KULICK DENTAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:ELIKASHVILI & KULICK DENTAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KULICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-725-7017
Mailing Address - Street 1:471 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-725-7017
Mailing Address - Fax:212-725-7017
Practice Address - Street 1:471 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-725-7017
Practice Address - Fax:212-725-7017
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELIKASHVILI & KULICK DENTAL ASSOCIATES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty