Healthcare Provider Details

I. General information

NPI: 1750449393
Provider Name (Legal Business Name): WHITESTONE DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 FRANCIS LEWIS BLVD
WHITESTONE NY
11357-3836
US

IV. Provider business mailing address

1815 FRANCIS LEWIS BLVD
WHITESTONE NY
11357-3836
US

V. Phone/Fax

Practice location:
  • Phone: 718-767-7276
  • Fax:
Mailing address:
  • Phone: 718-767-7276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number042587
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number034366
License Number StateNY

VIII. Authorized Official

Name: DR. SCOTT FRIEDMAN
Title or Position: OWNER
Credential: D.D.S.
Phone: 718-767-7276