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General NPI Number Information
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NPI Number | 1134439417
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Entity Type | Organization
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Legal Business Name | KEW GARDENS FAMILY DENTAL,PLLC
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 103 82ND AVENUE
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City | KEW GARDENS
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State | NY
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Zip | 11415-1423
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Country | US
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Telephone | 718-261-2065
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Fax |
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Provider Business Mailing Address
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Address Line | 103 82ND AVE
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City | KEW GARDENS
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State | NY
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Zip | 11415-1423
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Country | US
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Telephone | 718-261-2065
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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. AMBER T CHU
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Credential |
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Telephone | 718-261-2065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 050329
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License Number State | NY
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