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General NPI Number Information
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NPI Number | 1144916750
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Entity Type | Organization
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Legal Business Name | YUAN TIAN DENTAL PLLC
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Dates
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Enumeration Date | 04/17/2023
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 13630 MAPLE AVE STE 1H
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City | FLUSHING
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State | NY
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Zip | 11355-3869
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Country | US
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Telephone | 718-799-0779
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Fax | 718-799-0778
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Provider Business Mailing Address
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Address Line | 13630 MAPLE AVE STE 1H
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City | FLUSHING
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State | NY
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Zip | 11355-3869
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | YUAN TIAN
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Credential | DMD
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Telephone | 718-799-0779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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