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General NPI Number Information
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NPI Number | 1003195298
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Entity Type | Organization
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Legal Business Name | LIBERTY DENTAL CARE P.C.
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 08/05/2011
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Provider Practice Location Address
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Address Line | 11210 LIBERTY AVE
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-1814
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Country | US
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Telephone | 718-322-1415
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Fax | 718-880-2360
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Provider Business Mailing Address
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Address Line | 112-10 LIBERTY AVENUE
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419
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Country | US
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Telephone | 718-322-1415
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Fax | 718-880-2360
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHARLA SEUNARINE
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Credential | DDS
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Telephone | 718-322-1415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 046341
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 053394
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License Number State | NY
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