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NPI Code Detail

MEDICARE: G.L DENTAL PRACTICE

MEDICARE: G.L DENTAL PRACTICE
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
11223G0001XGeneral Practice Dentistry046122NY

General Provider Information

NPI Number : 1518984558
Entity Type Code : Organization
Provider Name (Legal Business Name) : G.L DENTAL PRACTICE
Provider Business Mailing Address
First Line : 22117 JAMAICA AVE
Second Line :
City : QUEENS VILLAGE
State : NY
Zip : 11428-2015
Country : US
Telephone Number : 718-454-4000
Fax Number : 718-479-9171
Provider Business Practice Location Address
First Line : 22117 JAMAICA AVE
Second Line :
City : QUEENS VILLAGE
State : NY
Zip : 11428-2015
Country : US
Telephone Number : 718-454-4000
Fax Number : 718-479-9171
Authorized Official
Title or Position : DENTIST
Name : DR. BABAK NAHAVANDI
Credential : DDS
Telephone Number : 718-454-4000
Provider Enumeration Date : 07/16/2006
Last Update Date : 08/22/2020

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Directions to “G.L DENTAL PRACTICE ” Practice Location

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