Provider Demographics
NPI:1053764118
Name:ORAL DENTAL HEALTH CARE, PLLC
Entity type:Organization
Organization Name:ORAL DENTAL HEALTH CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOHDAN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:NYCHKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-940-1155
Mailing Address - Street 1:189 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5587
Mailing Address - Country:US
Mailing Address - Phone:845-784-4202
Mailing Address - Fax:
Practice Address - Street 1:189 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5587
Practice Address - Country:US
Practice Address - Phone:845-784-4202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027576122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty