Healthcare Provider Details

I. General information

NPI: 1023719044
Provider Name (Legal Business Name): AHAVA KADISH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AHAVA KADISH

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24706 UNION TPKE
BELLEROSE NY
11426-1835
US

IV. Provider business mailing address

14732 68TH DR
FLUSHING NY
11367-2060
US

V. Phone/Fax

Practice location:
  • Phone: 718-347-6262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number061490
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: