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General NPI Number Information
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NPI Number | 1033565122
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Entity Type | Organization
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Legal Business Name | 92 JAMAICA AVE DENTISTRY PC
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Dates
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Enumeration Date | 05/09/2016
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Last Update Date | 05/09/2016
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Provider Practice Location Address
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Address Line | 9709 JAMAICA AVE
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City | WOODHAVEN
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State | NY
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Zip | 11421-2211
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Country | US
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Telephone | 917-776-7520
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Fax |
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Provider Business Mailing Address
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Address Line | 9709 JAMAICA AVE
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City | WOODHAVEN
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State | NY
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Zip | 11421-2211
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Country | US
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Telephone | 917-776-7520
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KAMROOZ KORORI
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Credential | DDS
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Telephone | 407-977-9230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 0491371
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License Number State | NY
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