Healthcare Provider Details

I. General information

NPI: 1427283969
Provider Name (Legal Business Name): NOBEL DENTAL CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87-02 188TH STREET
JAMAICA ESTATES NY
11423
US

IV. Provider business mailing address

87-02 188TH STREET
JAMAICA ESTATES NY
11423
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-2555
  • Fax:
Mailing address:
  • Phone: 718-264-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number043961
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number043961
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number043961
License Number StateNY

VIII. Authorized Official

Name: MANOLITO YAPCHULAY
Title or Position: OWNER
Credential: DDS, MSD
Phone: 718-264-2555