Provider Demographics
NPI:1902343080
Name:DYNASTY DENTAL CARE, PC
Entity Type:Organization
Organization Name:DYNASTY DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:D
Authorized Official - Last Name:BORUKHOV
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-263-4800
Mailing Address - Street 1:10915 QUEENS BLVD
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5482
Mailing Address - Country:US
Mailing Address - Phone:718-263-4800
Mailing Address - Fax:
Practice Address - Street 1:10915 QUEENS BLVD
Practice Address - Street 2:SUITE 1D
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5482
Practice Address - Country:US
Practice Address - Phone:718-263-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty