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General NPI Number Information
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NPI Number | 1053586164
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Entity Type | Organization
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Legal Business Name | RICHARD P. MEDINA, DDS, LLC
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 12/30/2015
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Provider Practice Location Address
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Address Line | 3719 88TH ST 1ST FL
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7630
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Country | US
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Telephone | 718-685-0031
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Fax | 718-685-0033
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Provider Business Mailing Address
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Address Line | 3719 88TH ST 1ST FL
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7630
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Country | US
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Telephone | 718-685-0031
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD P MEDINA
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Credential | DDS
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Telephone | 718-685-0031
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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 |
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License Number State |
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