Healthcare Provider Details

I. General information

NPI: 1962348219
Provider Name (Legal Business Name): MODERN DENTAL OF QUEENS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10026 67TH RD
FOREST HILLS NY
11375-2752
US

IV. Provider business mailing address

10026 67TH RD
FOREST HILLS NY
11375-2752
US

V. Phone/Fax

Practice location:
  • Phone: 718-452-5000
  • Fax:
Mailing address:
  • Phone: 718-452-5000
  • 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: MICHAEL YONAIEV
Title or Position: MANAGER
Credential:
Phone: 718-452-5000