Provider Demographics
NPI:1386072411
Name:WHITENING DENTAL ARTS PC
Entity type:Organization
Organization Name:WHITENING DENTAL ARTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALENTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LYSSOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-920-5953
Mailing Address - Street 1:131 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2604
Mailing Address - Country:US
Mailing Address - Phone:212-920-5953
Mailing Address - Fax:347-223-5036
Practice Address - Street 1:131 E 38TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2604
Practice Address - Country:US
Practice Address - Phone:212-920-5953
Practice Address - Fax:347-223-5036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052130122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty