Healthcare Provider Details

I. General information

NPI: 1770132037
Provider Name (Legal Business Name): MICHAEL AGHELIAN DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 NEREID AVE
BRONX NY
10466-1228
US

IV. Provider business mailing address

73 HICKS LN
GREAT NECK NY
11024-2027
US

V. Phone/Fax

Practice location:
  • Phone: 718-426-3000
  • Fax:
Mailing address:
  • Phone: 516-849-1439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL AGHELIAN
Title or Position: GENERAL DENTIST
Credential: DDS
Phone: 516-849-1439