Active NPI
Ik Dental
- Durable Medical Equipment & Medical Supplies
- New York, NY
National Provider Identifier
1104093814
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- 045540
- Legal business name
- IK DENTAL
- Practice address
- 4405 Broadway
New York, NY 10040-4014 - Phone
- (212) 568-1500
- Fax
- (855) 201-3647
- NPI assigned
- May 12, 2008
- Organization subpart
- Yes
- Parent organization
- YES
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Igor Klebanov, DDS
- Title
- Autherized Official
- Phone
- (212) 568-1500
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 045540 | NY | |
| Durable Medical Equipment & Medical Supplies | 332B00000X | 045540 | NY | Primary |
Addresses
Primary practice location
4405 Broadway
New York, NY 10040-4014
Mailing address
4405 Broadway
New York, NY 10040-4014
Phone (212) 568-1500
Other names 1
- ik dental
National Provider Directory
National Provider Directory- Part of
- Ik Dental PC
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- General Practice Dentistry
- Brooklyn, NY
- NPI 1376532671
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210550400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658361600000",
"number": "1104093814",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4405 BROADWAY",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100404014",
"telephone_number": "212-568-1500",
"fax_number": "855-201-3647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4405 BROADWAY",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100404014",
"telephone_number": "212-568-1500",
"fax_number": "855-201-3647"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "IK DENTAL",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "YES",
"enumeration_date": "2008-05-12",
"last_updated": "2022-07-21",
"status": "A",
"authorized_official_last_name": "KLEBANOV",
"authorized_official_first_name": "IGOR",
"authorized_official_title_or_position": "AUTHERIZED OFFICIAL",
"authorized_official_telephone_number": "212-568-1500",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "NY",
"license": "045540",
"primary": false
},
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NY",
"license": "045540",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "ik dental",
"code": "4",
"type": "Former Legal Business Name"
}
]
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.