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General NPI Number Information
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NPI Number | 1053788380
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Entity Type | Organization
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Legal Business Name | ASTORIA DENTAL DESIGN LLC
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Dates
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Enumeration Date | 08/21/2015
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Last Update Date | 08/21/2015
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Provider Practice Location Address
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Address Line | 15043 14TH AVE STE C
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City | WHITESTONE
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State | NY
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Zip | 11357-1817
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Country | US
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Telephone | 212-572-9800
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Fax | 347-436-9569
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Provider Business Mailing Address
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Address Line | 15043 14TH AVE STE C
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City | WHITESTONE
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State | NY
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Zip | 11357-1817
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Country | US
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Telephone | 212-572-9800
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Fax | 347-436-9569
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ANDREA SHIVRATTAN
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Credential |
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Telephone | 347-579-5159
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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 | 051604-1
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License Number State | NY
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