Healthcare Provider Details

I. General information

NPI: 1902125495
Provider Name (Legal Business Name): ROCKAWAY DENTAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2010
Last Update Date: 05/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 ROCKAWAY BLVD
SOUTH OZONE PARK NY
11420-2931
US

IV. Provider business mailing address

1040 1ST AVE #393
NEW YORK NY
10022-2991
US

V. Phone/Fax

Practice location:
  • Phone: 718-322-9607
  • Fax:
Mailing address:
  • Phone: 718-322-9607
  • 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: DR. THOMAS BEHM
Title or Position: DENTIST
Credential: DDS
Phone: 718-322-9607