Provider Demographics
NPI:1396376356
Name:I. PRODANOVA DDS, PC
Entity type:Organization
Organization Name:I. PRODANOVA DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IORDANKA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRODANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-216-9092
Mailing Address - Street 1:241 W 97TH ST APT 2N
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6207
Mailing Address - Country:US
Mailing Address - Phone:646-387-6083
Mailing Address - Fax:
Practice Address - Street 1:1 W 34TH ST RM 903
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2229
Practice Address - Country:US
Practice Address - Phone:212-216-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty