Healthcare Provider Details

I. General information

NPI: 1821775453
Provider Name (Legal Business Name): DANIELLE ZOYA MARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10210 66TH RD STE 1D
FOREST HILLS NY
11375-2047
US

IV. Provider business mailing address

10210 66TH RD STE 1D
FOREST HILLS NY
11375-2047
US

V. Phone/Fax

Practice location:
  • Phone: 718-275-9792
  • Fax:
Mailing address:
  • Phone: 718-275-9792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number065517
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: