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General NPI Number Information
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NPI Number | 1033125760
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Entity Type | Organization
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Legal Business Name | AC DENTAL
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3708 MAIN ST # 4/FL
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City | FLUSHING
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State | NY
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Zip | 11354-6509
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Country | US
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Telephone | 718-886-7222
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Fax | 718-886-6399
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Provider Business Mailing Address
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Address Line | 3708 MAIN ST # 4/FL
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City | FLUSHING
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State | NY
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Zip | 11354-6509
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Country | US
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Telephone | 718-886-7222
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Fax | 718-886-6399
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Authorized Official
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Title or Position | DENTIST
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Name | ANGELA LO
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Credential |
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Telephone | 718-886-7222
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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 | 047068
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License Number State | NY
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