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General NPI Number Information
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NPI Number | 1023170651
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Entity Type | Individual
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Provider Name | DESPINA DALLAS DDS
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Gender | Female
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3742 90 ST 1ST FLR
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372
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Country | US
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Telephone | 718-424-5559
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Fax | 718-426-2484
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Provider Business Mailing Address
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Address Line | 2007 27TH ST
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City | ASTORIA
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State | NY
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Zip | 11105
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Country | US
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Telephone | 718-626-3798
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Fax | 718-274-8442
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 052652
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License Number State | NY
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