Healthcare Provider Details

I. General information

NPI: 1073059283
Provider Name (Legal Business Name): YANDRESCO QUINTANA DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 W 180TH ST SUITE 1
NEW YORK NY
10033-4802
US

IV. Provider business mailing address

245 E 93RD ST APT 21A SUITE 1
NEW YORK NY
10128-3960
US

V. Phone/Fax

Practice location:
  • Phone: 212-927-0565
  • Fax:
Mailing address:
  • Phone: 212-927-0565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number057383
License Number StateNY

VIII. Authorized Official

Name: YANDRESCO QUINTANA
Title or Position: PRESSIDENT
Credential: M.D. D.D.S.
Phone: 212-927-0565