Healthcare Provider Details

I. General information

NPI: 1497399133
Provider Name (Legal Business Name): SKYLINE DENTAL PARTNERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 MAIN ST STE 411
FLUSHING NY
11354-5483
US

IV. Provider business mailing address

3901 MAIN ST STE 411
FLUSHING NY
11354-5483
US

V. Phone/Fax

Practice location:
  • Phone: 718-353-4908
  • Fax:
Mailing address:
  • Phone: 718-353-4908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. HOUSSAM ALKHOURY
Title or Position: OWNER
Credential: DMD
Phone: 508-505-5040