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Provider Information for 1144492687



GENNADIY KRAVETS D.M.D.

Gender: MALE

Individual NPI: 1144492687

Calendar Last Updated: 2008-03-25

Details

Name Value
NPI 1144492687
Enumeration Date 2008-03-25
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 202 UNION AVE SUITE D
BROOKLYN, NY 11211-7467
United States

Phone: 718-388-4613 | Fax: 718-388-4613
View Map External Link
Primary Practice Address 202 UNION AVE SUITE D
BROOKLYN, NY 11211-7467
United States

Phone: 718-388-4613 | Fax: 718-388-4613
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist NY 052594-1
Other Identifiers
Issuer State Number
MEDICAID NY 02721328