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General NPI Number Information
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NPI Number | 1053689463
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Entity Type | Organization
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Legal Business Name | GRAND DENTAL CARE PC
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 03/22/2012
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Provider Practice Location Address
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Address Line | 2000 GRAND AVE
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City | NORTH BALDWIN
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State | NY
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Zip | 11510-2811
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Country | US
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Telephone | 516-378-1968
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Fax | 516-608-9319
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Provider Business Mailing Address
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Address Line | 2000 GRAND AVE
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City | NORTH BALDWIN
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State | NY
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Zip | 11510-2811
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Country | US
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Telephone | 516-378-1968
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Fax | 516-608-9319
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FLORA ANGELA CHAVEZ-ROMERO
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Credential | DDS
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Telephone | 516-378-1968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 052129
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | P82633
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 046215
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License Number State | NY
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