360 Dental, PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

DS038816 Issued in PA

Legal business name

360 DENTAL, PC

Practice address

1350 E Lycoming St
Philadelphia, PA 19124-5354

Phone

(267) 242-1709

NPI assigned

Jun 10, 2015

Last updated

Jun 10, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mikhail Sitkovetsky, DDS

Title

Owner/Doctor

Phone

(215) 962-2242

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mikhail Sitkovetskiy, MIKHAIL SITKOVETSKIY

  • Dentist
  • Whitehall, PA
  • NPI 1679860852
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433894400000",
    "number": "1063893535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 E LYCOMING ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191245354",
            "telephone_number": "267-242-1709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 E LYCOMING ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191245354",
            "telephone_number": "267-242-1709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "360 DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-10",
        "last_updated": "2015-06-10",
        "status": "A",
        "authorized_official_last_name": "SITKOVETSKY",
        "authorized_official_first_name": "MIKHAIL",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "215-962-2242",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "PA",
            "license": "DS038816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Dental Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.