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General NPI Number Information
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NPI Number | 1073779112
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Entity Type | Organization
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Legal Business Name | QUALITY ORAL SURGERY CARE, P.C.
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 102 10 QUEENS BLVD
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City | FOREST HILLS
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State | NY
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Zip | 11375-4722
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Country | US
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Telephone | 718-544-4440
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Fax | 718-233-2723
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Provider Business Mailing Address
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Address Line | 102 10 QUEENS BLVD
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City | FOREST HILLS
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State | NY
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Zip | 11375-4722
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Country | US
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Telephone | 718-544-4440
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Fax | 718-233-2723
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Authorized Official
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Title or Position | ORAL SURGEON
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Name | DAVID TABAROKI
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Credential | D.D.S.
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Telephone | 917-848-6311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 052330
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 047690
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License Number State | NY
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