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NPI Code Detail

MEDICARE: DR. RICHARD P MEDINA DDS

MEDICARE: DR. RICHARD P MEDINA DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist047920NY
21223G0001XGeneral Practice Dentistry047920NY

General Provider Information

NPI Number : 1356553275
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD P MEDINA DDS
Provider Business Mailing Address
First Line : 3719 88TH ST FL 1
Second Line :
City : JACKSON HEIGHTS
State : NY
Zip : 11372-7630
Country : US
Telephone Number : 718-685-0031
Fax Number : 718-685-0033
Provider Business Practice Location Address
First Line : 3719 88TH ST FL 1
Second Line :
City : JACKSON HEIGHTS
State : NY
Zip : 11372-7630
Country : US
Telephone Number : 718-685-0031
Fax Number : 718-685-0033
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2007
Last Update Date : 07/25/2014

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Directions to “ DR. RICHARD P MEDINA DDS” Practice Location

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