Provider Demographics
NPI:1730347774
Name:KENSINGTON DENTAL ASSOCIATES PC
Entity type:Organization
Organization Name:KENSINGTON DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOFYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYNSHTEYN
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-436-9245
Mailing Address - Street 1:207 OCEAN PARKWAY
Mailing Address - Street 2:SUITE 1ST
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218
Mailing Address - Country:US
Mailing Address - Phone:718-436-9245
Mailing Address - Fax:718-436-0092
Practice Address - Street 1:207 OCEAN PARKWAY
Practice Address - Street 2:SUITE 1ST
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218
Practice Address - Country:US
Practice Address - Phone:718-436-9245
Practice Address - Fax:718-436-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0404791223G0001X
NY038940-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01734803Medicaid