MEDICARE: NORA FAMILY DENTA

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	122300000X	Dentist	049216	NY

General Provider Information

NPI Number	:	1831486067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORA FAMILY DENTA

Provider Business Mailing Address
First Line	:	18241 JAMAICA AVE
Second Line	:
City	:	HOLLIS
State	:	NY
Zip	:	11423-2329
Country	:	US
Telephone Number	:	718-657-0000
Fax Number	:	718-657-0000

Provider Business Practice Location Address
First Line	:	18241 JAMAICA AVE
Second Line	:
City	:	HOLLIS
State	:	NY
Zip	:	11423-2329
Country	:	US
Telephone Number	:	718-657-0000
Fax Number	:	718-657-0000

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. FLORA MOUNESSA
Credential	:	DDS
Telephone Number	:	718-657-0000

Provider Enumeration Date	:	07/08/2011
Last Update Date	:	07/08/2011

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Directions to “NORA FAMILY DENTA ” Practice Location

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