MEDICARE: SKYRAY DENTAL PC

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
1	1223G0001X	General Practice Dentistry	56872	NY

General Provider Information

NPI Number	:	1811420292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYRAY DENTAL PC

Provider Business Mailing Address
First Line	:	13107 40TH RD
Second Line	:	SUITE E36
City	:	FLUSHING
State	:	NY
Zip	:	11354-5116
Country	:	US
Telephone Number	:	718-888-1817
Fax Number	:	631-602-5555

Provider Business Practice Location Address
First Line	:	13107 40TH RD
Second Line	:	SUITE E36
City	:	FLUSHING
State	:	NY
Zip	:	11354-5116
Country	:	US
Telephone Number	:	718-888-1817
Fax Number	:	631-602-5555

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LEI HUANG
Credential	:	DDS
Telephone Number	:	718-888-1817

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	04/04/2017

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