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General NPI Number Information
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NPI Number | 1205197142
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Entity Type | Organization
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Legal Business Name | QLG DENTAL, PC
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 09/24/2012
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Provider Practice Location Address
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Address Line | 5906 7TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11220-4121
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Country | US
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Telephone | 646-248-2946
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Fax |
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Provider Business Mailing Address
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Address Line | 8420 51ST AVE 2F
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City | ELMHURST
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State | NY
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Zip | 11373-5808
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Country | US
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Telephone | 646-248-2946
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | QIAO LING GUO
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Credential | DDS
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Telephone | 646-248-2946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0541881
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License Number State | NY
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