Provider Demographics
NPI:1568257681
Name:NEWAGEDENTAL II PC
Entity type:Organization
Organization Name:NEWAGEDENTAL II PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:KIRILL
Authorized Official - Middle Name:
Authorized Official - Last Name:VASILYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-650-6200
Mailing Address - Street 1:9733 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3231
Mailing Address - Country:US
Mailing Address - Phone:215-774-5050
Mailing Address - Fax:215-437-7874
Practice Address - Street 1:9733 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3231
Practice Address - Country:US
Practice Address - Phone:215-774-5050
Practice Address - Fax:215-437-7874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty