Healthcare Provider Details

I. General information

NPI: 1376799510
Provider Name (Legal Business Name): AUSTIN DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7017 AUSTIN ST #3D
FOREST HILLS NY
11375-4722
US

IV. Provider business mailing address

7017 AUSTIN ST #3D
FOREST HILLS NY
11375-4722
US

V. Phone/Fax

Practice location:
  • Phone: 718-544-4440
  • Fax: 718-233-2723
Mailing address:
  • Phone: 718-544-4440
  • Fax: 718-233-2723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. FARANAK BALAZADEH
Title or Position: DENTIST
Credential: DDS
Phone: 718-544-4440