Gentle Dental Church Avenue Pllc

NPI #1295266930 in Brooklyn, New York

Provider Information

NPI Number: 1295266930
Entity Type: Organization
Organization Name: Gentle Dental Church Avenue Pllc
Primary Specialty: Dentist
Enumeration Date: Mar 24, 2017
Last Updated: Mar 24, 2017

Practice Location

Address: 4711 CHURCH AVE
Address 2: 2ND FLOOR, DENTAL SUITE
City: Brooklyn
State: New York
ZIP Code: 11203-3209
Phone: (718) 485-4111

Authorized Official

Name: DR. ROBERT FATAKHOV, DDS
Title: OWNER
Phone: (718) 485-4111

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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