Avenue U Orthodontics, PLLC
Dentist, Orthodontics and Dentofacial Orthopedics in Brooklyn, NY. Organization (NPI-2).
NPI number1164575478
StatusActive
Last updated in NPPESAug 31, 2020
Details
- NPI
- 1164575478
- Entity type
- Organization (NPI-2)
- Legal business name
- Avenue U Orthodontics, PLLC
- Organization subpart
- No
- Enumeration date
- Jan 19, 2007
- Certification date
- Aug 31, 2020
- Last updated
- Aug 31, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223X0400X | Dentist, Orthodontics and Dentofacial Orthopedics | – | – | Yes |
| 1223X0400X | Dentist, Orthodontics and Dentofacial Orthopedics | DI20707 | NJ |
Other names
- Orthoclub PC (Former Legal Business Name)
Practice location
79 Avenue UBrooklyn, NY 11223-3554
Phone 718-373-6707 · Fax 888-292-7017
Mailing address
15 Engle StreetSuite 204
Englewood, NJ 07631-2936
Phone 201-308-8181 · Fax 888-292-7017
Authorized official
Oleg Drut
Owner
2013088181
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