Provider Demographics
NPI:1427783489
Name:MODERN DAY DENTAL
Entity type:Organization
Organization Name:MODERN DAY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:TARAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KULYNYCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-494-8065
Mailing Address - Street 1:2050 SAINT JOHNS PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4593
Mailing Address - Country:US
Mailing Address - Phone:914-494-8065
Mailing Address - Fax:
Practice Address - Street 1:2050 SAINT JOHNS PKWY STE 102
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-4593
Practice Address - Country:US
Practice Address - Phone:914-494-8065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental