Provider Demographics
NPI:1528738309
Name:PAPANDO DENTAL PC
Entity type:Organization
Organization Name:PAPANDO DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPANDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-998-2424
Mailing Address - Street 1:245 96TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6847
Mailing Address - Country:US
Mailing Address - Phone:917-250-6396
Mailing Address - Fax:718-998-4092
Practice Address - Street 1:2464 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5008
Practice Address - Country:US
Practice Address - Phone:718-998-2424
Practice Address - Fax:718-998-4092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04521555Medicaid