Provider Demographics
NPI:1902232739
Name:METROTECH SMILE DENTAL P.C
Entity Type:Organization
Organization Name:METROTECH SMILE DENTAL P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-488-8585
Mailing Address - Street 1:350 FULTON ST
Mailing Address - Street 2:2 ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5123
Mailing Address - Country:US
Mailing Address - Phone:718-488-8585
Mailing Address - Fax:718-246-3823
Practice Address - Street 1:350 FULTON ST
Practice Address - Street 2:2 ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5123
Practice Address - Country:US
Practice Address - Phone:718-488-8585
Practice Address - Fax:718-246-3823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0565901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty